Midterm Flashcards
Describe the location and action of cueform cartliages
The lateral of the two bumps in the glottis
Spring-like action
Sequence of RSI
Sedate, NMBD, sellick
What is the most likely glottic action to occur following extubation of a patient who suffered bilateral RLN injuries during surgery?
Injury - VC closed
Interruption - VC at cadaveric position
For a patient with moderate septal deviation, how many turbinates will be out of the normal anatomic position?
None (b/c turbinates are on lateral wall)
What is the action of the transverse arytenoideus?
ADduction
When do symptoms (eg, dyspnea) appear when an orificial lesion is progressively obstructing the upper airway?
70%
What is the peak age for which foreign body aspirations occur?
2 years old
If questioned about the likelihood of being hoarse postop, what incidence would you site in your explanation to a patient?
3%, resolves on own in 1-3 days
If inadvertent endobronchial intubatio occurs, which lobe of the lungs will most likely be atelectatic postop?
Right upper lobe
A 4 yo suspected of aspirating a marble needs to undergo GA to remove foreign body. She is dyspneic, stridorous, uncooperative, and SpO2 is 86% and she doesn’t have an IV. What is the best induction plan for this patient?
Inhalational induction with Sevo, O2, and Helium
What size connection exits (?) for attaching an anesthesia breathing circuit to a rigid bronchoscope?
15 mm ?
What does the thyroid gland secrete?
T3 & T4
The facial nerve provides:
A) sensory
B) motor
C) both
C) both
Motor threshold for NMB stimulation of the adductor pollicis occurs at what mA?
15 mA
For an adult male, the cricoid cartilage is found at what C-spine level?
C6
The superior laryngeal nerve is a branch of what nerve?
Vagus
Where does the smallest cross-sectional area of the adult larynx occur?
glottis
What effect on striated muscle does hypocalcemia produce?
Tetany, weakness (?)
What nerve pierces the thyrohyoid membrane?
Internal branch of the superior laryngeal nerve.
For an adult, the VC would be found at approximately what C-spine level?
C4
What does the parotid gland secrete?
Saliva, digestive enyme
How many branches of the facial nerve are there in the face and neck?
5
Temporal
Zygomatic
Buccal
Mandibular
Cervical
Chvostek’s sign is useful in assessing what electrolyte abnormality?
Ca2+, hypocalcemia
Supramaximal stimulus for NMB monitoring using adductor pollicis should be set at how many mA?
40 mA
Dorsal depression of which laryngeal structure should be employed to improve view of the glottis when the initial DL view was only the tip of the epiglottis?
thyroid cartilage
In what position will you find the right VC if there has been interruption of the right laryngeal nerve in the past 6 hours?
Paramedian
Sensory threshold for NMB stimulation of the adductor pollicis occurs at how many mA?
5 mA
Name one branch of the facial nerve that you can use for NMB monitoring
Temporal
What is teh OD of an endotracheal tube connector?
15 mm
What is the ID of an anesthesia face bask connection?
22mm
Which is the more medial pair of cartilages, cuneform or corniculate?
Corniculate
(Cuneform are lateral)
What is lateral to the true vocal cordes?
Vesticular folds
What is the name for the maneuver to decrease intrathoracic pressure by attempting to inhale against a closed glottis?
Mueller maneuver
The type of complication that a sore throat represents is: acute, intermediate, or long-term?
Long-term
When no intrinsic laryngeal muscle action is occurring, in what position will the VC appear during DL?
Paramedian
Maximal adduction will move the VC into what position?
Midline
If nerver conduction in both SLN of an awake patien is diminished, the patient’s voice will
Change pitch
What LA should be used to perform a SLN block?
A) Bupivicaine
B) Cocaine
C) Lidocaine
D) Prilocaine
E) Tetracain
C, lidocaine
High pitch, crackle, inspiratory, lower airway
A) Rales
B) Stridor
C) Ronchi
D) Wheezing
E) Stertor
Rales
High pitch, inpiratory & expiratory, upper airway
A) Rales
B) Stridor
C) Ronchi
D) Wheezing
E) Stertor
Stridor
Low pitch, inspiratory/expiratory, lower airway
A) Rales
B) Stridor
C) Ronchi
D) Wheezing
E) Stertor
Ronchi
Whistle, inspiratory/expiratory, lower airway
A) Rales
B) Stridor
C) Ronchi
D) Wheezing
E) Stertor
Wheezing
Snore, inspiratory/expiratory, upper airway
A) Rales
B) Stridor
C) Ronchi
D) Wheezing
E) Stertor
Stertor
Tracheostomy, surgical requirement for postop airway safety
Stay suture to ensure access to trach
Desaturation, FRC, weight
35 mL/kg = FRC
kg0.75 (x) 10 = VO2
FRC * FiO2/VO2 = time to hypoxia
Cuff-leak test
5-10 cmH2O
if > 20 cmH2O –> keep intubated
Secondary trach, complications
>24 hrs - increased risk for bleeding & infection
Cicatricial stenosis, management
Treatment is surgery
ulcer –> granuloma –> cicatricial stenosis
????
Postop stridor evaluation
Supraglottic edema
RLN injury and hypcalcemia are rare
Airway edema, racemic epi
Aersolized
Airway examination and evaluation, gravid patient
Supine position
VC ulceration management
Strict vocal rest and observation
Oxygen consumption calculation
kg0.75 (x) 10 = VO2
Hoarseness preop management
Rule out direct VC involvement, thyroid issues RLN/SLN
>2 weeks requires otolaryngoscopy
Most frequent laryngeal malignancy
Squamous cell
VC, ulceration, endotracheal intubation
Ulceration on posterior aspect of VC
Thyroid disease produces what kind of flow-volume loop
Extrathoracic, inspiratory plateau
Breath sounds, stridor
Shrill, high pitched
Airway management during GA in pt with laryngectomy
Laryngoflex tube
Larynx functions
Protection, effort closure, phonation
Acute epiglottitis airway management
OETT, remain intubated, pt transport on heliox
Vertebral level of hypoid bone
C3
Rales breath sounds
crackling, high pitched
Definition of overjet
Hoirzontal
Etiology of otitis media with nasotracheal instrumentation
misplaced nasal tube in eustacian tube
Sensory innervation of the face
CN V - trigeminal
Heliox concentration
Use 80/20
Geriatrics, airway management related risks
>80 yo, FRC unchanged
Parotid gland secretion
Saliva
Definition, deciduous and permanent
Adults = 32 teeth
Kids = 20 teeth
Gastric pressure, gravid patient
1 child = +7 - 17 cmH2O
2 children = +7 - 40 cmH2O
Lithotomy = +7 - 24 cmH2O
Breath sounds, rhonchi
vibration, low pitch
Congenital airway disease, laryngomalacia
Stridor = hallmark, inspiratory
Tracheal ring level for elective tracheostomy
2nd or 3rd ring
What is the length of an adult male’s trachea
11-12 cm
Name the two movements the arytenoid cartilage makes
Rotating and gliding
What structure provides the fulcrum point for the larynx?
Hyoid bone
Four functions of the human larynx
Phonation
Effort closure
Prevent aspirations
Conduct air???