ENT randomness from handouts

Question 1

what is the most freq indication for laryngectomy?

Answer 1

squamous cell cancer - which is highly correlated with etoh and tobacco use.

Question 2

what is the most common site of laryngectomy? second? third?

Answer 2

glottis — supraglottic — subglottic

Question 3

what is the fx of the larynx?

Answer 3

support and protect the airway, create voice

Question 4

what are the 3 unpaired cartilages

Answer 4

epiglottis, thyroid, cricoid

Question 5

what are the 3 paired cartilages

Answer 5

arytenoid, corniculate, cuneiform

Question 6

what makes up the supraglottic region?

Answer 6

epiglottis, arytenoid, false cords

Question 7

what makes up the glottis?

Answer 7

true VC and glottis opening

Question 8

extrinsic muscles move the larynx __ and ___

Answer 8

up and down (sternothyroid, thyohypoid, inferior constrictor of the pharynx)

Question 9

intrinsic muscles provide vocal cord ____ and ____

Answer 9

tension and relaxation

Question 10

the RLN provides sensory to……..??????

Answer 10

everything below the level of the vocal cords

Question 11

the RLN provides motor to….?????

Answer 11

all laryngeal muscles except the cricothyroid

Question 12

SLN ____ branch provides ___ above vocal cords

Answer 12

internal, sensory above vocal cords

Question 13

SLN ____ branch provides motor ___

Answer 13

external, cricothyroid

Question 14

where does the blood supply for the SLN come from

Answer 14

external carotid

Question 15

where does the blood supply for the inferior laryngeal artery come from?

Answer 15

subclavian

Question 16

venous return is via ___ and _____ laryngeal veins

Answer 16

superior, inferior

Question 17

what is associated with stiffening and scarring of tissues, making intubation more problematic?

Answer 17

radiation therapy

Question 18

what are the most common complications of laryngectomy?

Answer 18

pharyngocutaneous fistula and wound infection

Question 19

T/F There is an increased risk for aspiration with partial laryngectomy.

Answer 19

TRUE

Question 20

T/F The most important prognostic factor for squamous cell cancer in the head and neck is the status of the lymph nodes and the extent of the lymphadenopathy.

Answer 20

TRUE

Question 21

what structures foes radical neck dissection include?

Answer 21

complete cervical lymphadenectomy, resection of the sternocleidomastoid muscle, the IJ vein, spinal accessory nerve, and the submandibular gland

Question 22

RND: Head of bed will be ___ to ameliorate the effects of jugular vein ligation, increase venous return and decrease blood loss.

Answer 22

elevated

Question 23

what is the greatest risk of RND?

Answer 23

damage to nerve, muscles, veins

Question 24

RND - horner’s syndrome is a concern d/t cervical sympathetic chain interruption.. what are the 3 characteristics?

Answer 24

ptosis, myosis, anhydrosis

Question 25

Following RND, the patient has stooped shoulders, decreased ability to lift their arm on the operative side, and limited head and neck rotation and flexion from removal of nerves and muscles. what is your plan?

Answer 25

nothing , this is expected

Question 26

RND: ____ may form at the end of dissected nerves, causing chronic paresthesias and pain

Answer 26

neuromas

Question 27

___ ____ nerve trauma results in painful shoulder syndrome, weakness, limited ROM, and winging of scapula.

Answer 27

Spinal accessory

Question 28

what produces lower lip weakness after RND?

Answer 28

facial nerve injury to small branch (marginal mandibular branch)

Question 29

Post op htn and lack of hypoxic drive after a BILATERAL RND may indicate????

Answer 29

damage to the carotid bodies and sinuses.

Question 30

RND: vocal cord paralysis and sensory dysfunction may also indicate???

Answer 30

vagus nerve damage d/t the innervation of the larynx.

Question 31

what are the s/s of a VAE

Answer 31

cyanosis, hotn, dysrhythmias, ST segment elevation, drop in ETCO2, increase in ETN2, and mill wheel, charring sound murmur over lower borders of the sternum

Question 32

what are the anesthetic interventions for VAE

Answer 32

inform surgeon so he can flood site with saline and compress the vessels to prevent further entrapment of air. anesthesia must increase FIO2 1.0, turn patient to left side head down and support circulation. aspiration of air from the heart via a central venous catheter and cardiac massage may be required.

Question 33

venous air embolism is a risk due to a large vein being opened in the neck. it passes to ____ and causes an airlock at the level of the ____ and the ____.

Answer 33

right atrium, right atrium, SVC

Question 34

why should you be careful with fluids for a patient who has had a previous RND

Answer 34

they have derangements of their lymphatic drainage patterns. their tissues do not tolerate the edema produced by the insult of surgery.

Question 35

if you have delayed awakening in an RND patient, what do you suspect?

Answer 35

cephalic venous obstruction —- result of central apnea syndrome d/t acutely elevated ICP.

Question 36

what are 3 signs of cephalic venous obstruction?

Answer 36

significant facial edema, facial cyanosis despite normal pulse ox, rhinorrhea.

Question 37

how should you treat cephalic venous obstruction

Answer 37

measures that decrease ICP and preserve intracranial flow

some examples would be: hyperventilation, propofol, avoid htn, avoid NTG/SNP, elevate head >30 degrees to facilitate venous drainage from the brain, reduce intrathoracic pressure (PEEP increases it!), diuretics, steroids

Question 38

if there is muscular effort to breathe during apnea, it is termed ____

Answer 38

obstructive

Question 39

UPP is done for patient with ____

Answer 39

OSA that can’t tolerate CPAP BIPAP

Question 40

hypopnea: abnormal resp event with a >___% drop in airflow compared to baseline), lasting at least ____s, with a __% drop in O2 sat

Answer 40

30% drop in airflow.
at least 10s
>4% drop in O2 sat

Question 41

Apnea Hypopnea Index: 
\_\_\_ events = none
\_\_\_ events  = mild
\_\_\_ events  =  mod
\_\_\_ events  = severe

Answer 41

0-5 events = none.
6-20 events = mild
21-40 events = mod
>40 events = severe

Question 42

difficult airway: < __ fingers thyromental, >__cm intercisor

Answer 42

3fingers, 3cm

Question 43

OSA patients - sleep patterns are deranged for ___ following surgery?

Answer 43

one week

Question 44

The thyroid produces and secretes thyroid hormones T3 and T4 in a ratio of :

Answer 44

10:1

Question 45

what is stronger… T3 or T4?

Answer 45

T3 has 4x the potency of T4

Question 46

graves disease is ____, hasimotos is _____

Answer 46

hyperthyroid, hypothyroid

Question 47

myxedema coma is ___ , thyroid storm is ___

Answer 47

hypo, hyper

Question 48

what does a NIM tube monitor?

Answer 48

RLN function

Question 49

what are two things that can effect NIM tube monitoring during thyroid surgery

Answer 49

NMB and laryngotracheal lidocaine.

Question 50

when does thyroid storm usually occur

Answer 50

6-18h post-op. it’s most common in people with Graves and not euthyroid prior to surgery

Question 51

what are drugs given to theat thyroid storm

Answer 51

sodium iodide to block realize of hormone from the gland, tylenol, metoprolol/esmolol, decadron/hydrocortisone,

Methimazole (PTU) or propylthiouracil to inhibit further synthesis of thyroid hormone

Question 52

unilateral RLN damage results in?

Answer 52

horseness

Question 53

bilateral RLN damage results in ?

Answer 53

aphonia, stridor or resp distress

Question 54

hematoma usually occurs ___h after thyroid surgery

Answer 54

6-24

Question 55

thyroid surgery- what causes acute hypocalcemia?

Answer 55

inadvertent removal of parathyroids. most likely to occur 24-48h later.