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45 Cards in this Set
- Front
- Back
What kind of lesion will cause a decrement to the inspiratory portion of the flow volume loop?
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Extrathoracic lesion
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What kind of lesion will cause a decrement in the expiratory portion of the flow volume loop?
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intrathoracic lesion
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What are important problems encountered during laryngoscopy?
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airway obstruction, sympathetic stimulation causing myocardial ischemia, myocardial depression from volatile anesthetic
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How does a variable intrathoracic lesion affect the flow volume loop?
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expiratory decrement
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How does a variable extrathoracic lesion affect the flow volume loop?
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inspiratory decrement
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What is the max dose of cocaine?
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3mg/kg
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How does cocaine affect catecholamines?
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increases plasma levels of catecholamines(by decreasing the reuptake at the nerve terminal)
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How and where is tyrosine converted to norepi?
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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
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How are catecholamines inactivated in the synaptic cleft?
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2/3's are removed from the synaptic cleft by reuptake into the nerve terminal
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What blocks norepi reuptake?
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cocaine, TCA, amphetamines
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What happens to norepi not taken up by nerve terminal?
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enters circulation and then is broken down by MAOi, COMT
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What are complications of nasotracheal intubation?
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dislodgement of arytenoids, adenoids, polyps, nasal necrosis, sinusitis, false passage into nasal mucosa, epistaxis, otitis media,ulceration of inferior turbinate, laryngitis, pharyngitis
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What should you consider about using N2O during ear surgery?
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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
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Why should you be cautious about using muscle relaxants during ear surgery?
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they may have to monitor the facial nerve
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What kind of lasers are the argon, yag, ruby and how can they damage the eye?
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short wavelength(0.5-1.0microns), can cause retinal damage
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What kind of laser is the CO2 laser and how can it damage the eye?
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infrared(10microns); corneal injury(burns)
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What is the only tube that will not ignite when struck by a laser?
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metal(Norton) tube; silicon or wrapped(aluminum foil) are quite resistant
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What are complications of LASER use?
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airway fire, eye damage, tissue damage, eye injury to OR personnel
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How do you treat an airway fire?
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stop N2O, stop all gas flow, extubate, support airway with mask, perform bronchoscopy and esophagoscopy to assess damage
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What are the major disadvantages of supra and subglottic jet ventilation?
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supraglottic: movement of vocal cords and splattering of debris and secretions into the operative field, aspiration; subglottic: risk of barotrauma, aspiration
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How much is 50psi in cm water pressure?
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3500cm water pressure(14.7psi=760mmhg, 1mm Hg=1.36cm H20)
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What are complications of jet ventilation?
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pneumomediastinum, ptx, gastric distention, hypoventilation
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What are the leading causes of death associated with tonsillectomy?
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hemorrhage and respiratory obstruction
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What should you evaluate preop in a patient presenting for a tonsilectomy?
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partial airway obstruction can lead to chronic hypoxia, hypercarbia, acidosis
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if a patient presents for tonsillectomy with obstructive symptoms how should you induce them?
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do not render the patient apneic, inhalation induction is a good idea
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How should you manage the airway of a patient with bleeding tonsils?
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RSI or awake intubation, vigorous fluid resuscitation prior to anesthesia(likely hypovolemic)
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How do you treat postop stridor or hoarseness?
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100% humidified O2 by mask, racemic epi(0.5cc of 2.25% in 3cc NS over 10-15min), decadron 1mg/kg, intubation if necessary
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What nerves must be blocked for an awake intubation?
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glossopharyngeal, vagus(do not need to block hypoglossal)
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What are the steps to preparing a patient for an awake fiberoptic intubation?
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1. antisialogogue 2. 4% lido start at tongue and move posterior 3. block gag reflex
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What mediates the gag reflex and how is it blocked?
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CN IX; block the lingual branch of CN IX at the lateral base of the tongue
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How do you block the gag reflex?
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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
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How is the superior larygeal nerve blocked?
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just inferior to the greater cornu of the hyoid; 25 g needle at the greater cornu of the hyoid bone bilaterally
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What does the internal and external laryngeal branches of the superior laryngeal nerve innervate?
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internal: sensation from the epiglottis, both laryngeal and buccal surfaces to the vocal cords(it pierces the thyrohyoid membrane); external: cricothyroid muscle
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What is another name for the recurrent laryngeal nerve?
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inferior laryngeal nerve
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How is the recurrent laryngeal nerve blocked?
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transtracheal injection(enters larynx just posterior to the cricothyroid articulation); neck fully extended, enter cricothyroid with a 20g needle
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What is innervated by the recurrent laryngeal nerve?
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sensation to the area below the vocal cords as well as control over all of the laryngeal muscles except cricothyroid
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What is the most common nerve injured during thyroid surgery?
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recurrent laryngeal(hoarseness)
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What nerve must be blocked for an awake tracheostomy?
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recurrent laryngeal
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What nerve must be blocked to prevent coughing in an awake intubation?
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recurrent larygeal, superior laryngeal, glossopharyngeal
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What medication should be considered when using lidocaine for an awake intubation?
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versed or valium(raises the seizure threshold)
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What are EKG manifestations of local anesthetic toxicity?
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prolonged PR interval, wide QRS, asystole
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What are manifestations of cocaine toxicity?
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HTN, arrhythmias, MI, hyperthermia,
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What is the motor innervation of the tongue?
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CN XII supplies all except palatoglossus muscle which is innervated by the pharyngeal plexus
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What is the sensory innervation of the tongue?
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ant 2/3s mandibular branch of trigeminal(also floor of mouth), glossopharyngeal provides sensation to the post 1/3 of tongue
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What is the innervation of the tonge with respect to taste?
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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
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