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Principles2 > ENT > Flashcards

ENT Flashcards

1
Q

special ENT considerations:

  1. restricted use of what? (MR)
  2. what 2 things are shared? (A, SF)
  3. frequently these procedures are of what duration? (S)
A
  1. muscle relaxant
  2. airway, surgical field
  3. short
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2
Q

what are the 4 paired sinuses? (F, E, M, S)

A
  1. frontal
  2. ethmoid
  3. maxillary
  4. sphenoid
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3
Q

Pharynx:

  1. what are the 2 major functions? (V, AP)
  2. extends to what number cervical vertebrae?
A
  1. voice, air passage

2. 6

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4
Q

Larynx:

  1. what are the 4 primary functions? (V, A, AP, AR)
  2. what is the narrowest portion of the airway in adults?
A
  1. vocalization, articulation, airway protection, allows respiration
  2. vocal cords
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5
Q

laryngeal cartilage:

  1. what are the 3 unpaired cartilages? (T, E, C)
  2. what are the 3 paired cartilages? (A, C, C)
A
  1. thyroid, epiglottis, cricoid

2. arytenoid, corniculate, cuneiform

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6
Q

what laryngeal muscle does these functions:

  1. adducts VCs
  2. abducts VCs
  3. closes glottis
  4. controls sphincters to vestibule (decreases larynx volume)
  5. tenses (lengthens) VCs
  6. relaxes (shortens) VCs
A
  1. lateral cricoarytenoid
  2. posterior cricoarytenoid
  3. transverse arytenoid
  4. oblique arytenoid
  5. cricothyroid
  6. thyroarytenoid
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7
Q

what CN or nerve has sensory innervation:

  1. supplies anterior 2/3 of the tongue
  2. supplies posterior 1/3 of the tongue to the epiglottis
  3. epiglottis to and including the VCs
  4. below the VCs to the trachea
A
  1. CN 5
  2. CN 9
  3. SLN
  4. RLN
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8
Q

SLN and RLN are part of which CN?

A

CN 10 (vagus nerve)

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9
Q

Motor innervation:

  1. almost all muscles of the larynx are controlled by which nerve?
  2. what muscle is innervated by the SLN?
A
  1. RLN

2. cricothyroid

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10
Q

table may be turned what degree range?

A

90-180 degrees

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11
Q

ETTs:

  1. NIM EMG (nerve integrity monitoring) is used to assess what 2 nerve functions? (R, L)
  2. laser tubes are filled with what to diagnose ignition and cuff rupture?
  3. what are the 2 high flow jet ventilation tubes? (C, XTMJT)
A
  1. recurrent, laryngeal
  2. methylene blue
  3. carden, xomed-treace mon-jet tube
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12
Q

Laser technology:

  1. laser light is different from standard light because it is how many wave lengths?
  2. what are the 2 most common lasers used in ENT? (C, Nd:YAG)
  3. enables very precise excision to produce minimal what 2 things? (E, B)
A
  1. 1
  2. CO2, neodymium-doped yttrium aluminum garnet
  3. edema, bleeding
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13
Q

Laser safety:

  1. post what when laser in use? (WS)
  2. pts eyes should be cover with what 2 things? (G, MG)
  3. OR personnel should wear what? (PG)
  4. should nitrous be used?
  5. use of O2 concentration should be hi or low?
  6. laser should be in what mode when not in use? (S)
  7. use what that is specifically made for lasers? (E)
  8. cuff should be inflated with what? (MBTS)
  9. all adjacent tissues should be over with ath? (WG)
  10. plume (vapors) should be what and what from surgical field (S, E)
A
  1. warning sign
  2. glasses, moist gauze
  3. protective glasses
  4. no
  5. low
  6. standby
  7. ETT
  8. methylene blue tinged saline
  9. wet gauze
  10. suctioned, evacuated
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14
Q

airway fire:

  1. what is the number one cause? (L)
  2. typically d/t the what penetrating through the what? (L, E)
  3. are O2 and nitrous both combustible?
  4. the three elements for any fire are a what material, a what source, and a what that supports combustion? (C, I, A)
A
  1. laser
  2. laser through the ETT
  3. yes
  4. combustible material, ignition source, atmosphere that supports combustion
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15
Q

Reduce fire:

  1. use what based lubricants? (WB)
  2. all alcohol prep solutions should be what? (D)
  3. avoid what type of surgical drapes? (P)
  4. hi or low O2?
A
  1. water based
  2. dry
  3. paper
  4. low
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16
Q

response to airway fire:

  1. Immediately stop what and remove what? (V, E)
  2. Turn off what and disconnect circuit from the what? (O, M)
  3. Irrigate site with what? (W)
  4. ventilate the patient via what or do what in order to ventilate the pt? (M, R)
  5. evaluate the patient with what? (B)
  6. give what 2 med types? (A, S)
  7. pt will probably need care where? (I)
A
  1. ventilating, ETT
  2. O2, machine
  3. water
  4. mask, reintubate
  5. bronchoscope
  6. abx, steroids
  7. ICU
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17
Q

vasoactive drugs:

  1. most ENT cases require what type of anesthetic?
  2. epi is frequently used to decrease the chance of what and to increase what? (SA, D)
  3. safe dose of epi is how many mcg or how many mcg/kg?
  4. what is the only LA with vasoconstrictive properties?
  5. what is the mg/kg dose of cocaine 4%?
  6. cocaine 4% is hydrolyzed by what? (PC)
  7. what are 4 SEs of cocaine 4%? (H, T, D, HA)
A
  1. local anesthetics
  2. systemic absorption, duration
  3. 200 mcg or 1.5 mcg/kg
  4. cocaine 4%
  5. 3 mg/kg
  6. plasma cholinesterase
  7. HTN, tachycardia, dysrhythmias, headache
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18
Q

transtrcheal block:

  1. what membrane is identified and puncture?
  2. confirm what aspiration before injecting LA?
  3. what LA is used with % and how many mLs are used?
  4. what pt reaction confirms location and also spread of LA through the trachea? (C)
A
  1. cricothyroid
  2. air aspiration
  3. 4% lido, 4 mL
  4. cough
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19
Q

glossopharyngeal nerve block:

  1. LA is injected into the base of what arch?
  2. what gauge spinal needle is used?
  3. how many mL of LA is sued?
A
  1. palatoglossal arch
  2. 25 gauge
  3. 2 mL
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20
Q

superior laryngeal nerve block

  1. LA is infiltrated how man cm below each greater cornu of what bone? (H)
  2. what LA is used with % and how many mLs are used?
A
  1. 1 cm, hyoid bone

2. 2% lido, 3 mL

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21
Q

topical spray:

  1. what 2 LAs can be used? (L, C)
  2. remember that mucosal absorption=what? (IVA)
  3. topical cocaine can be used where? (N)
A
  1. lidocaine, cetacaine
  2. IV absorption
  3. nose
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22
Q

Additional ENT meds:

  1. what 3 types of drugs are considered additional? (AA, C, AE)
  2. what is one anesthesia technique that can be used for controlled hypotensive technique? (HNT)
  3. what 1 med type and what are 2 meds that can be used for controlled hypotensive techniques? (BB, N, N)
A
  1. antisialagogue agents, corticosteroids, anti-emetics
  2. high narcotic technique
  3. beta blockers, nicardipine, nitroglycerin
23
Q

what is the most common endoscopic surgery?

A

sinus surgery

24
Q

benzocaine can cause what condition? (M)

A

methemoglobinemia

25
Q

pt who receive topical anesthetics need to be NPO at least how many hours postop?

A

2 hours

26
Q

what is intermittent apnea?

A

ETT is removed briefly while the surgeon operate then the pt is reintubated and ventilated

27
Q

use a small cuffed ETT (5.0-6.0 mm for adults) for what -scopy?

A

microlaryngoscopy

28
Q

use a large ETT for what?

A

bronchoscopy

29
Q

Endoscopy complications:

  1. trauma to what 2 areas? (E, T)
  2. perforation of what 2 things? (A, E)
  3. what are 6 other complications? (B, L, E, L, P)
A
  1. eye, teeth
  2. airway, esophagus
  3. bronchospasm, laryngospasm, epistaxis, LAST, pneumo
30
Q

Bronchoscopy:

  1. flexible bronchoscopy can be done under what? (S)
  2. rigid bronchoscopy has to be done under what?
  3. can connect the anesthesia circuit to the side port of the what? (S)
  4. what laser is used for tumor debulking? (Y)
A
  1. sedation
  2. GA
  3. scope
  4. Yag
31
Q

Sinus surgery

  1. may be associated with what 2 things on induction? (RAD, AO)
  2. when surgeon uses LAs with epi, be prepared for what 2 things? (HI, D)
  3. since sinuses are very vascular, controlled hypotension should be used with the MAP at what mmHg if tolerated?
  4. what tube should be used and taped midline?
A
  1. reactive airway disease, airway obstruction
  2. hemodynamic instability, dysrhythmia
  3. 60 mmHg
  4. Oral RAE
32
Q

sinus surgery:

  1. suction what at end of surgery to minimize N&V? (GC)
  2. head is up to what degrees?
  3. minimal narcotics are needed and minimal postop pain d/t the use of what?
  4. nasal packing will add to what postop? (AO)
  5. avoiding what on extubation? (B)
  6. what type of O2 in recovery? (H)
  7. should antiemetics be given?
A
  1. gastric contents
  2. 30 degrees
  3. LAs
  4. airway obstruction
  5. bucking
  6. humidified
  7. yes
33
Q

for a venous air embolism, does ETCO2 go up or down?

A

down

34
Q

Foreign body aspiration:

  1. is is the leading cause of accidental death in children less than 1?
  2. where is the most common site? (RMB)
  3. what are 6 signs of aspiration? (C,C,C,A,T,W)
  4. anesthesia technique depends on what 3 things? (AOL, OS, OS)
A
  1. yes
  2. right mainstem bronchus
  3. choking, coughing, cyanosis, aphonia, tachycardia, wheezing
  4. airway obstruction location, object size, obstruction severity
35
Q

Foreign body aspiration level of the larynx:

  1. simple laryngoscopy with what forceps? (M)
  2. premedicate with what 3 drugs? (G,P,R)
  3. what type of induction and maintain what? (I, SV)
  4. anticipate what type of airway obstruction? (C)
A
  1. magill
  2. glycopyrrolate, pepcid, reglan
  3. inhalation induction, spontaneous ventilation
  4. complete
36
Q

Foreign body aspiration level of the distal larynx or trachea:

  1. GA is required with what allowing the surgeon to use what to extract the foreign body? (SV, RB)
  2. what 3 premeds are given? (G,P, R)
  3. ventilation will be via what on either the laryngoscope or the bronchoscope? (SP)
  4. what are used to remove the item via the eyepiece of the bronchoscope? (F)
  5. keep what 3 things high to compensate for the air leak? (O, GF, TV)
  6. what mg/kg of decadron can be given to decrease subglottic edema?
  7. what med can be given in the PACU to decrease subglottic edema? (RE)
  8. what type of maintenance GA can be used?
A
  1. spontaneous ventilation, rigid bronchoscope
  2. glycopyrrolate, pepcid, reglan
  3. side port
  4. forceps
  5. oxygen, gas flows, tidal volumes
  6. 0.25-1 mg/kg
  7. racemic epi
  8. TIVA
37
Q

Tonsillectomy and Adenoidectomy:

  1. high incidence of what? (AO)
  2. short procedure with the desire for rapid what? (A)
  3. bloody airway with high incidence of what? (N,V)
  4. usual what type of induction in peds? (I)
  5. give what premed to peds? (V)
  6. what ETT and secured where?
  7. give what 2 med types? (O, S)
  8. what type of extubation? (A)
A
  1. airway obstruction
  2. awakening
  3. nausea, vomiting
  4. inhalation
  5. versed
  6. oral RAE, midline
  7. opioids, steroids
  8. awake
38
Q

bleeding post tonsillectomy:

  1. incidence that requires surgical interventions is what % range?
  2. what % of postop hemorrhages occur 6 hours after surgery?
  3. what % occur within the next 24 hours?
  4. a major concern is the pt did what to a large volume of blood before bleeding is discovered? (S)
  5. these pts are at a high risk of what on induction? (A)
  6. should you empty the stomach before induction?
  7. should induction agents be chosen that preserve cardiac stability?
A
  1. 0.3-0.6%
  2. 75%
  3. 25%
  4. swallowed
  5. aspiration
  6. yes
  7. yes
39
Q

cleft lip and palate:

  1. intubation is straight forward unless the blade continues to fall into the what? (C)
  2. doing what to the cleft helps with intubation? (P)
  3. what type of ETT down the center is sufficient?
  4. surgeons place what in the tongue to pull it forward and alleviate airway obstruction postop? (S)
  5. extubate awake d/t copious amounts of what 2 things? (S, B)
  6. avoid what post extubation? (OA)
  7. do these pts go to the ICU?
A
  1. cleft
  2. packing
  3. oral RAE
  4. sutures
  5. secretion, bood
  6. oral airway
  7. yes
40
Q

ear surgery:

  1. avoid what 1 drug and 1 type of drug?
  2. is there a high degree of PONV?
  3. what type of technique? (N)
  4. can’t use nitrous because it can diffuse into the cavity and displace the what? (G)
  5. what is being watched for preservation, which does not allow for the use of MRs?
  6. what CNs are being watched?
A
  1. nitrous, MRs
  2. yes
  3. narcotic
  4. graft
  5. watching for CN preservation
  6. 7, 9, 10, 11, 12
41
Q

cochlear implants:

  1. electrodes are placed for direct stimulation of what nerve? (A)
  2. give what type of med? (A)
  3. avoid what type of med?
  4. avoid what 3 things? (C, S, B)
  5. this is safely performed in infants greater than how many months of age?
A
  1. auditory
  2. antiemetics
  3. MRs
  4. coughing, straining, bucking
  5. 6 months
42
Q

dental restoration:

  1. majority are done under what type of anesthesia?
  2. what type of intubation is needed?
A
  1. GA

2. nasal

43
Q

radical neck dissection:

  1. oropharyngeal and laryngeal compromise what % range of all cancers in the U.S.?
  2. more men or women?
  3. what % of them are over 60 years old?
  4. pts might receive what prior to surgery? (R)
  5. tumors tend to be what and to do what easily? (F, B)
  6. what is the most frequent surgery? (TL)
A
  1. 3-5%
  2. men
  3. 75%
  4. radiation
  5. friable, bleed
  6. total laryngectomy
44
Q

total laryngectomy:

  1. removal of what bone, the entire what, what cartilage, and 2 or 3 rings of the what? (H, L, C, T)
  2. what 3 structures remain? (T, PW, LT)
  3. do these pts have a voice?
  4. what do this pts breathe via?
  5. do these pts have swallowing issues?
A
  1. hyoid bone, entire larynx, cricoid cartilage, trachea
  2. tongue, pharyngeal wall, lower trachea
  3. no
  4. tracheostomy
  5. no
45
Q

supraglottic laryngectomy:

  1. remove what 3 things? (HB, E, FVC)
  2. what 3 things remain? (TVC, CC, T)
  3. is voice normal?
  4. does aspiration occur occasionally?
A
  1. hyoid bone, epiglottis, false VCs
  2. true VCs, cricoid cartilage, trachea
  3. yes
  4. yes
46
Q

partial laryngectomy:

  1. remove one what? (VC)
  2. do all the other structures remain?
  3. in one word, describe their voice?
  4. do these pts have a problem swallowing?
A
  1. vocal cord
  2. yes
  3. hoarse
  4. no
47
Q

radical neck dissection:

  1. most airways will be done how?
  2. short or long procedures?
  3. HOB at what degrees?
  4. ICU stay overnight d/t worried about what? (AE)
  5. what type of infusion is used? (N)
A
  1. awake
  2. long
  3. 30 degrees
  4. airway edema
  5. narcotic infusion
48
Q

what are 5 radical neck dissection complications? (VAE, HI, P, PE, DT)

A
  1. venous air embolism
  2. hemodynamic instability
  3. pneumo
  4. pulmonary edema
  5. delirium tremors
49
Q

maxillofacial trauma:

  1. what must be maintained during intubation? (MILS)
  2. what type of line might be placed to help with controlled hypotension?
A
  1. manual in-line stabilization

2. art line

50
Q

Le Fort 1:

  1. fx of the upper or lower maxilla?
  2. separation of what 3 things from the maxilla? (HP, AP, UT)
  3. in one word, describe the airway compromise? (M)
  4. may be intubated in what 2 ways?
A
  1. lower
  2. hard palate, alveolar processes, upper teeth
  3. minimal
  4. orally, nasally
51
Q

Le Fort 2:

  1. in one word, describe the amount of the maxilla that is free floating? (M)
  2. pyradial fx from the bridge of the what through the what 2 walls of orbit? (N, M, I)
  3. can these pts be nasally intubated?
A
  1. most
  2. nose, medial, inferior
  3. no
52
Q

Le Fort 3:

  1. complete separation of the midface from the what, and extending through what 2 things and what region? (S, O, N)
  2. can these pts be nasally intubated?
A
  1. skull, orbits, nasoethmoidal

2. no

53
Q

what laryngeal muscle does these functions:

  1. lateral cricoarytenoid does what to the VCs?
  2. posterior cricoarytenoid does what to the VCs?
  3. cricothyroid tenses or relaxes the VCs?
  4. thyroarytenoid tenses or relaxes the VCs?
  5. the transverse arytenoid closes what?
  6. the oblique arytenoid controls the sphincters where and decreases what volume? (V, L)
A
  1. adducts
  2. abducts
  3. tenses (lengthens)
  4. relaxes (shortens)
  5. glottis
  6. vestibule, larynx

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