Midterm Flashcards by Diane Kohn

Describe the location and action of cueform cartliages

The lateral of the two bumps in the glottis

Spring-like action

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Sequence of RSI

Sedate, NMBD, sellick

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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

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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)

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What is the action of the transverse arytenoideus?

ADduction

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When do symptoms (eg, dyspnea) appear when an orificial lesion is progressively obstructing the upper airway?

70%

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What is the peak age for which foreign body aspirations occur?

2 years old

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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

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If inadvertent endobronchial intubatio occurs, which lobe of the lungs will most likely be atelectatic postop?

Right upper lobe

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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

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What size connection exits (?) for attaching an anesthesia breathing circuit to a rigid bronchoscope?

15 mm ?

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What does the thyroid gland secrete?

T3 & T4

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The facial nerve provides:
A) sensory
B) motor
C) both

C) both

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Motor threshold for NMB stimulation of the adductor pollicis occurs at what mA?

15 mA

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For an adult male, the cricoid cartilage is found at what C-spine level?

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The superior laryngeal nerve is a branch of what nerve?

Vagus

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Where does the smallest cross-sectional area of the adult larynx occur?

glottis

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What effect on striated muscle does hypocalcemia produce?

Tetany, weakness (?)

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What nerve pierces the thyrohyoid membrane?

Internal branch of the superior laryngeal nerve.

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For an adult, the VC would be found at approximately what C-spine level?

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What does the parotid gland secrete?

Saliva, digestive enyme

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How many branches of the facial nerve are there in the face and neck?

Temporal
Zygomatic
Buccal
Mandibular
Cervical

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Chvostek’s sign is useful in assessing what electrolyte abnormality?

Ca²⁺, hypocalcemia

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Supramaximal stimulus for NMB monitoring using adductor pollicis should be set at how many mA?

40 mA

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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

kg^0.75 (x) 10 = V_O2

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

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???