Bb Ent

Front 1

What kind of lesion will cause a decrement to the inspiratory portion of the flow volume loop?

Back 1

Extrathoracic lesion

Front 2

What kind of lesion will cause a decrement in the expiratory portion of the flow volume loop?

Back 2

intrathoracic lesion

Front 3

What are important problems encountered during laryngoscopy?

Back 3

airway obstruction, sympathetic stimulation causing myocardial ischemia, myocardial depression from volatile anesthetic

Front 4

How does a variable intrathoracic lesion affect the flow volume loop?

Back 4

expiratory decrement

Front 5

How does a variable extrathoracic lesion affect the flow volume loop?

Back 5

inspiratory decrement

Front 6

What is the max dose of cocaine?

Back 6

3mg/kg

Front 7

How does cocaine affect catecholamines?

Back 7

increases plasma levels of catecholamines(by decreasing the reuptake at the nerve terminal)

Front 8

How and where is tyrosine converted to norepi?

Back 8

tyrosine is hydroxylated and converted to dopamine in the cytoplasm of the sympathetic nerve terminal, dopamine then enters the storage granules and vesicles where it is converted to norepi

Front 9

How are catecholamines inactivated in the synaptic cleft?

Back 9

2/3's are removed from the synaptic cleft by reuptake into the nerve terminal

Front 10

What blocks norepi reuptake?

Back 10

cocaine, TCA, amphetamines

Front 11

What happens to norepi not taken up by nerve terminal?

Back 11

enters circulation and then is broken down by MAOi, COMT

Front 12

What are complications of nasotracheal intubation?

Back 12

dislodgement of arytenoids, adenoids, polyps, nasal necrosis, sinusitis, false passage into nasal mucosa, epistaxis, otitis media,ulceration of inferior turbinate, laryngitis, pharyngitis

Front 13

What should you consider about using N2O during ear surgery?

Back 13

if eustacian tube is narrowed(inflammation, scar tissue), the ability of N2O to be vented is decreased, N2O can enter the middle ear and lead to tympanic membrane rupture or perforation

Front 14

Why should you be cautious about using muscle relaxants during ear surgery?

Back 14

they may have to monitor the facial nerve

Front 15

What kind of lasers are the argon, yag, ruby and how can they damage the eye?

Back 15

short wavelength(0.5-1.0microns), can cause retinal damage

Front 16

What kind of laser is the CO2 laser and how can it damage the eye?

Back 16

infrared(10microns); corneal injury(burns)

Front 17

What is the only tube that will not ignite when struck by a laser?

Back 17

metal(Norton) tube; silicon or wrapped(aluminum foil) are quite resistant

Front 18

What are complications of LASER use?

Back 18

airway fire, eye damage, tissue damage, eye injury to OR personnel

Front 19

How do you treat an airway fire?

Back 19

stop N2O, stop all gas flow, extubate, support airway with mask, perform bronchoscopy and esophagoscopy to assess damage

Front 20

What are the major disadvantages of supra and subglottic jet ventilation?

Back 20

supraglottic: movement of vocal cords and splattering of debris and secretions into the operative field, aspiration; subglottic: risk of barotrauma, aspiration

Front 21

How much is 50psi in cm water pressure?

Back 21

3500cm water pressure(14.7psi=760mmhg, 1mm Hg=1.36cm H20)

Front 22

What are complications of jet ventilation?

Back 22

pneumomediastinum, ptx, gastric distention, hypoventilation

Front 23

What are the leading causes of death associated with tonsillectomy?

Back 23

hemorrhage and respiratory obstruction

Front 24

What should you evaluate preop in a patient presenting for a tonsilectomy?

Back 24

partial airway obstruction can lead to chronic hypoxia, hypercarbia, acidosis

Front 25

if a patient presents for tonsillectomy with obstructive symptoms how should you induce them?

Back 25

do not render the patient apneic, inhalation induction is a good idea

Front 26

How should you manage the airway of a patient with bleeding tonsils?

Back 26

RSI or awake intubation, vigorous fluid resuscitation prior to anesthesia(likely hypovolemic)

Front 27

How do you treat postop stridor or hoarseness?

Back 27

100% humidified O2 by mask, racemic epi(0.5cc of 2.25% in 3cc NS over 10-15min), decadron 1mg/kg, intubation if necessary

Front 28

What nerves must be blocked for an awake intubation?

Back 28

glossopharyngeal, vagus(do not need to block hypoglossal)

Front 29

What are the steps to preparing a patient for an awake fiberoptic intubation?

Back 29

1. antisialogogue 2. 4% lido start at tongue and move posterior 3. block gag reflex

Front 30

What mediates the gag reflex and how is it blocked?

Back 30

CN IX; block the lingual branch of CN IX at the lateral base of the tongue

Front 31

How do you block the gag reflex?

Back 31

hold tongue laterally, place a 25g spinal needle in the trough where the tongue meets the glossopalatine arch inject 1-2cc of local anesthetic(anesthetizes post 1/3 of tongue and vallecula

Front 32

How is the superior larygeal nerve blocked?

Back 32

just inferior to the greater cornu of the hyoid; 25 g needle at the greater cornu of the hyoid bone bilaterally

Front 33

What does the internal and external laryngeal branches of the superior laryngeal nerve innervate?

Back 33

internal: sensation from the epiglottis, both laryngeal and buccal surfaces to the vocal cords(it pierces the thyrohyoid membrane); external: cricothyroid muscle

Front 34

What is another name for the recurrent laryngeal nerve?

Back 34

inferior laryngeal nerve

Front 35

How is the recurrent laryngeal nerve blocked?

Back 35

transtracheal injection(enters larynx just posterior to the cricothyroid articulation); neck fully extended, enter cricothyroid with a 20g needle

Front 36

What is innervated by the recurrent laryngeal nerve?

Back 36

sensation to the area below the vocal cords as well as control over all of the laryngeal muscles except cricothyroid

Front 37

What is the most common nerve injured during thyroid surgery?

Back 37

recurrent laryngeal(hoarseness)

Front 38

What nerve must be blocked for an awake tracheostomy?

Back 38

recurrent laryngeal

Front 39

What nerve must be blocked to prevent coughing in an awake intubation?

Back 39

recurrent larygeal, superior laryngeal, glossopharyngeal

Front 40

What medication should be considered when using lidocaine for an awake intubation?

Back 40

versed or valium(raises the seizure threshold)

Front 41

What are EKG manifestations of local anesthetic toxicity?

Back 41

prolonged PR interval, wide QRS, asystole

Front 42

What are manifestations of cocaine toxicity?

Back 42

HTN, arrhythmias, MI, hyperthermia,

Front 43

What is the motor innervation of the tongue?

Back 43

CN XII supplies all except palatoglossus muscle which is innervated by the pharyngeal plexus

Front 44

What is the sensory innervation of the tongue?

Back 44

ant 2/3s mandibular branch of trigeminal(also floor of mouth), glossopharyngeal provides sensation to the post 1/3 of tongue

Front 45

What is the innervation of the tonge with respect to taste?

Back 45

ant 2/3's chorda tympani branchi of CN VII, CN IX provides taste to post 1/3, superior laryngeal nerve provides sensation to the root and the epiglottis