Respiratory station

Question 1

Station 1: Ultrasound

Answer 1

1. Internal Jugular is lateral to the carotid
2. Lung sliding on US indicates no pneumothorax
3. Normal: sand on the beach appearance

Question 2

Station 2: Lymph Drainage

Answer 2

LLL lymph drainage crosses over and drains to the right side

Question 3

Pneumonia on CXR

Answer 3

1. RML heard on axilla a 6th intercostal space.
   1b. White opacities over the R heart border on PA view
   2 RLL pneumonia looks like triangle on lateral view
2. Diaphragm goes from 8th to 10th rib; COPD extends to 12th rib

Question 4

Neck layers for Cricothrodotomy and Central line

Answer 4

Skin, subcutaneous fat, internal fascia, muscle, internal fascia, pareital pleura, visceral pleura

Question 5

Station 4: Pancoast tumor

Answer 5

Sx: Ulnar nerve irritation (C8-T1), asymmetric pupillary constriction (miosis), anhidrosis, ptosis, Horner’s syndrome (tumor near stellate ganglion)

Question 6

Station 5: Central line

Answer 6

1. Get as close to SVC/IVC as possible
2. IVJ is best (lateral to carotid)
3. Best to do on right side because L lung is higer (risk of pneumothorax)
4. DONT LET GO OF WIRE

Question 7

Station 6: Pneumothorax

Answer 7

1. Tension pneumothorax is a clinical dx
2. Needle decompression at 2nd ICS MCL
3. Chest tube 4th ICS at MCL

Question 8

Parotidis

Answer 8

Staph Aureus mcc) affects the superior laryngeal n, so patient loses their cough reflex and will develop aspiration– the superior laryngeal is sensory only for the ipsilateral vocal cords.

Use hyoid bone to find superior laryngeal nerve

Question 9

Station 8: Cricothyroidotomy

Answer 9

1. Facial trauma, foriegn body, burns, angioedema
2. Locate the thyroid and cricoid cartilage and go in between the two in the cricothyroid membrane need to cut VERTICALLY (to avoid vessels)
3. Convert to tracheostomy (more stable)
4. Tracheosotmy tube should not go lower than carina

Question 10

Which artery is mcc for posterior nose bleed?

Answer 10

Sphenopalantine artery

Tx: When applying nasal packaging aim for the occiput, do not follow the bridge of the nose.
Apply pressure, Ice, and oxymetazoline

Question 11

Station 11: Retropharyngeal space

Answer 11

Boundaries
Lateral: Carotid sheaths
Posterior: Prevertebral Fascia
Anterior: Buccopharyngeal fascia

Alar fascia b/t prevertebral and buccopharyngeal fascia

Question 12

Tonsils

Answer 12

Palantine tonsils are between the palatoglossal and palatopharyngeal arches.

Waldeyer’s ring incorporates the pharyngeal, tubal, lingual and palatine tonsils