ENT

Question 1

which nerves supply the ear

Answer 1

auriculotemporal. greater auricular, auricular branch of vagus, tympanic

Question 2

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

Answer 2

50

Question 3

when would you use facial nerve monitoring

Answer 3

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

Question 4

head ___ position will reduce venous pressure and bleeding

Answer 4

up

Question 5

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

Answer 5

50-60

hr 60

Question 6

small doses of cocaine are ___, decrease HR.

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

Answer 6

vagotonic.

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

Question 7

what is Samter’s triad?

Answer 7

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

Question 8

whats the dose for rectal tylenol

Answer 8

10-15mg/kg

Question 9

whats the dose for zofran

Answer 9

100-150mcg/kg

Question 10

what is larsons maneuver

Answer 10

gentle positive pressure with anterior pressure at angle of ramus check

Question 11

bleeding tonsil - post-op bleeding ____ with age

Answer 11

increases

Question 12

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

Answer 12

6h, venous or capillary

Question 13

what are suggestive s/s of bleeding tonsil?

Answer 13

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

Question 14

what is a late light of bleeding tonsil?

Answer 14

hypotension

Question 15

how should you intubate a bleeding tonsil patient?

Answer 15

RSI, head down if tolerated

Question 16

how should you mask the patient?

Answer 16

lateral or head down

Question 17

presence of stridor indicates

Answer 17

4-5

Question 18

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

Answer 18

surpaglottic. upper esophageal

Question 19

___ stridor suggests extra thoracic airway obstruction

Answer 19

inspiratory

Question 20

____ stridor suggests intrathoracic airway obstuction

Answer 20

expiratory

Question 21

___ laser is most commonly used in microlaryngoscopy

Answer 21

CO2

Question 22

what are the risks associated with the laser?

Answer 22

airway fire, stray laser beam hazardous to OR personnel

Question 23

what are the 3 things needed for fire

Answer 23

fuel, oxidant, and ignition(heat) source

Question 24

YAG laser = ___ lens googles

Answer 24

green

Question 25

Argon laser = ____ lens googles

Answer 25

amber

Question 26

CO2 = ___ lens

Answer 26

clear

Question 27

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

Answer 27

disconnect circuit

Question 28

what are the issues associated with supraglottic jet ventilation

Answer 28

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

Question 29

subglottic jet vent has ___ risk barotrauma than supraglottic

Answer 29

greater

Question 30

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

Answer 30

small, rapid

Question 31

HFPPV (positive pressure ventilation) resp rates =

Answer 31

60-120

Question 32

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

Answer 32

resp rates =100-140. | tidal volumes less than dead space

Question 33

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?

Answer 33

use a high intensity suction catheter near the mouth to clear

Question 34

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

Answer 34

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

Question 35

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

Answer 35

TRUE.

Question 36

the venturi bronchoscope uses the same principles of ____

Answer 36

sanders type injector | 16g jet on side arm of laryngoscope or bronchoscope

Question 37

PCO2 accumulates ____ for every minute of apnea

Answer 37

3-4torr

Question 38

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

Answer 38

hypoxemia, hypoventilation

Question 39

GETA fiberoptic - ETT no smaller than ____

Answer 39

8-9

Question 40

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

Answer 40

PEEP, decreases

Question 41

T/F Esophagoscopy requires a large ETT

Answer 41

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

Question 42

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

Answer 42

Esophagoscopy

Question 43

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

Answer 43

perforation, esp if object is sharp

Question 44

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

Answer 44

reinforced tube

Question 45

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

Answer 45

organic. it can soften, expand, and fragment.

Question 46

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

Answer 46

TRUE

Question 47

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

Answer 47

lateral, affected side DOWN

Question 48

racemic epi treatments may be repeated every ___ min

Answer 48

30

Question 49

whats the dose for decahedron for foreign body removal?

Answer 49

0.5-1.5 mg/kg

Question 50

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

Answer 50

haemophilus influenza type B and group A strep. | viral - parainfluenza virus

Question 51

epiglottitis is typical in which age group?

Answer 51

3-5yo

Question 52

epiglottitis peaks which time of year ?

Answer 52

spring and fall

Question 53

what are the 4 D's associated with epiglottitis?

Answer 53

dysphagia, dysphonia, dyspnea, and drooling

Question 54

T/F epiglottitis patients present with hoarseness.

Answer 54

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

Question 55

lateral neck x-ray "____" at epiglottis

Answer 55

thumb sign

Question 56

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

Answer 56

tripod

Question 57

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

Answer 57

FALSE just sevo and 100% fio2

Question 58

How should you determine your ETT size for epiglottitis?

Answer 58

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

Question 59

Does the epiglottitis patient usually get extubated?

Answer 59

no they remain intubated for 24-48h

Question 60

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

Answer 60

7

Question 61

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

Answer 61

TRUE

Question 62

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

Answer 62

reintubate from larynx. try a smaller size tube.

Question 63

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

Answer 63

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