ENT

Question 1

special ENT considerations:

1. restricted use of what? (MR)
2. what 2 things are shared? (A, SF)
3. frequently these procedures are of what duration? (S)

Answer 1

1. muscle relaxant
2. airway, surgical field
3. short

Question 2

what are the 4 paired sinuses? (F, E, M, S)

Answer 2

1. frontal
2. ethmoid
3. maxillary
4. sphenoid

Question 3

Pharynx:

1. what are the 2 major functions? (V, AP)
2. extends to what number cervical vertebrae?

Answer 3

1. voice, air passage

2. 6

Question 4

Larynx:

1. what are the 4 primary functions? (V, A, AP, AR)
2. what is the narrowest portion of the airway in adults?

Answer 4

1. vocalization, articulation, airway protection, allows respiration
2. vocal cords

Question 5

laryngeal cartilage:

1. what are the 3 unpaired cartilages? (T, E, C)
2. what are the 3 paired cartilages? (A, C, C)

Answer 5

1. thyroid, epiglottis, cricoid

2. arytenoid, corniculate, cuneiform

Question 6

what laryngeal muscle does these functions:

1. adducts VCs
2. abducts VCs
3. closes glottis
4. controls sphincters to vestibule (decreases larynx volume)
5. tenses (lengthens) VCs
6. relaxes (shortens) VCs

Answer 6

1. lateral cricoarytenoid
2. posterior cricoarytenoid
3. transverse arytenoid
4. oblique arytenoid
5. cricothyroid
6. thyroarytenoid

Question 7

what CN or nerve has sensory innervation:

1. supplies anterior 2/3 of the tongue
2. supplies posterior 1/3 of the tongue to the epiglottis
3. epiglottis to and including the VCs
4. below the VCs to the trachea

Answer 7

1. CN 5
2. CN 9
3. SLN
4. RLN

Question 8

SLN and RLN are part of which CN?

Answer 8

CN 10 (vagus nerve)

Question 9

Motor innervation:

1. almost all muscles of the larynx are controlled by which nerve?
2. what muscle is innervated by the SLN?

Answer 9

1. RLN

2. cricothyroid

Question 10

table may be turned what degree range?

Answer 10

90-180 degrees

Question 11

ETTs:

1. NIM EMG (nerve integrity monitoring) is used to assess what 2 nerve functions? (R, L)
2. laser tubes are filled with what to diagnose ignition and cuff rupture?
3. what are the 2 high flow jet ventilation tubes? (C, XTMJT)

Answer 11

1. recurrent, laryngeal
2. methylene blue
3. carden, xomed-treace mon-jet tube

Question 12

Laser technology:

1. laser light is different from standard light because it is how many wave lengths?
2. what are the 2 most common lasers used in ENT? (C, Nd:YAG)
3. enables very precise excision to produce minimal what 2 things? (E, B)

Answer 12

1. 1
2. CO2, neodymium-doped yttrium aluminum garnet
3. edema, bleeding

Question 13

Laser safety:

1. post what when laser in use? (WS)
2. pts eyes should be cover with what 2 things? (G, MG)
3. OR personnel should wear what? (PG)
4. should nitrous be used?
5. use of O2 concentration should be hi or low?
6. laser should be in what mode when not in use? (S)
7. use what that is specifically made for lasers? (E)
8. cuff should be inflated with what? (MBTS)
9. all adjacent tissues should be over with ath? (WG)
10. plume (vapors) should be what and what from surgical field (S, E)

Answer 13

1. warning sign
2. glasses, moist gauze
3. protective glasses
4. no
5. low
6. standby
7. ETT
8. methylene blue tinged saline
9. wet gauze
10. suctioned, evacuated

Question 14

airway fire:

1. what is the number one cause? (L)
2. typically d/t the what penetrating through the what? (L, E)
3. are O2 and nitrous both combustible?
4. the three elements for any fire are a what material, a what source, and a what that supports combustion? (C, I, A)

Answer 14

1. laser
2. laser through the ETT
3. yes
4. combustible material, ignition source, atmosphere that supports combustion

Question 15

Reduce fire:

1. use what based lubricants? (WB)
2. all alcohol prep solutions should be what? (D)
3. avoid what type of surgical drapes? (P)
4. hi or low O2?

Answer 15

1. water based
2. dry
3. paper
4. low

Question 16

response to airway fire:

1. Immediately stop what and remove what? (V, E)
2. Turn off what and disconnect circuit from the what? (O, M)
3. Irrigate site with what? (W)
4. ventilate the patient via what or do what in order to ventilate the pt? (M, R)
5. evaluate the patient with what? (B)
6. give what 2 med types? (A, S)
7. pt will probably need care where? (I)

Answer 16

1. ventilating, ETT
2. O2, machine
3. water
4. mask, reintubate
5. bronchoscope
6. abx, steroids
7. ICU

Question 17

vasoactive drugs:

1. most ENT cases require what type of anesthetic?
2. epi is frequently used to decrease the chance of what and to increase what? (SA, D)
3. safe dose of epi is how many mcg or how many mcg/kg?
4. what is the only LA with vasoconstrictive properties?
5. what is the mg/kg dose of cocaine 4%?
6. cocaine 4% is hydrolyzed by what? (PC)
7. what are 4 SEs of cocaine 4%? (H, T, D, HA)

Answer 17

1. local anesthetics
2. systemic absorption, duration
3. 200 mcg or 1.5 mcg/kg
4. cocaine 4%
5. 3 mg/kg
6. plasma cholinesterase
7. HTN, tachycardia, dysrhythmias, headache

Question 18

transtrcheal block:

1. what membrane is identified and puncture?
2. confirm what aspiration before injecting LA?
3. what LA is used with % and how many mLs are used?
4. what pt reaction confirms location and also spread of LA through the trachea? (C)

Answer 18

1. cricothyroid
2. air aspiration
3. 4% lido, 4 mL
4. cough

Question 19

glossopharyngeal nerve block:

1. LA is injected into the base of what arch?
2. what gauge spinal needle is used?
3. how many mL of LA is sued?

Answer 19

1. palatoglossal arch
2. 25 gauge
3. 2 mL

Question 20

superior laryngeal nerve block

1. LA is infiltrated how man cm below each greater cornu of what bone? (H)
2. what LA is used with % and how many mLs are used?

Answer 20

1. 1 cm, hyoid bone

2. 2% lido, 3 mL

Question 21

topical spray:

1. what 2 LAs can be used? (L, C)
2. remember that mucosal absorption=what? (IVA)
3. topical cocaine can be used where? (N)

Answer 21

1. lidocaine, cetacaine
2. IV absorption
3. nose

Question 22

Additional ENT meds:

1. what 3 types of drugs are considered additional? (AA, C, AE)
2. what is one anesthesia technique that can be used for controlled hypotensive technique? (HNT)
3. what 1 med type and what are 2 meds that can be used for controlled hypotensive techniques? (BB, N, N)

Answer 22

1. antisialagogue agents, corticosteroids, anti-emetics
2. high narcotic technique
3. beta blockers, nicardipine, nitroglycerin

Question 23

what is the most common endoscopic surgery?

Answer 23

sinus surgery

Question 24

benzocaine can cause what condition? (M)

Answer 24

methemoglobinemia

Question 25

pt who receive topical anesthetics need to be NPO at least how many hours postop?

Answer 25

2 hours

Question 26

what is intermittent apnea?

Answer 26

ETT is removed briefly while the surgeon operate then the pt is reintubated and ventilated

Question 27

use a small cuffed ETT (5.0-6.0 mm for adults) for what -scopy?

Answer 27

microlaryngoscopy

Question 28

use a large ETT for what?

Answer 28

bronchoscopy

Question 29

Endoscopy complications: 1. trauma to what 2 areas? (E, T) 2. perforation of what 2 things? (A, E) 3. what are 6 other complications? (B, L, E, L, P)

Answer 29

1. eye, teeth 2. airway, esophagus 3. bronchospasm, laryngospasm, epistaxis, LAST, pneumo

Question 30

Bronchoscopy: 1. flexible bronchoscopy can be done under what? (S) 2. rigid bronchoscopy has to be done under what? 3. can connect the anesthesia circuit to the side port of the what? (S) 4. what laser is used for tumor debulking? (Y)

Answer 30

1. sedation 2. GA 3. scope 4. Yag

Question 31

Sinus surgery 1. may be associated with what 2 things on induction? (RAD, AO) 2. when surgeon uses LAs with epi, be prepared for what 2 things? (HI, D) 3. since sinuses are very vascular, controlled hypotension should be used with the MAP at what mmHg if tolerated? 4. what tube should be used and taped midline?

Answer 31

1. reactive airway disease, airway obstruction 2. hemodynamic instability, dysrhythmia 3. 60 mmHg 4. Oral RAE

Question 32

sinus surgery: 1. suction what at end of surgery to minimize N&V? (GC) 2. head is up to what degrees? 3. minimal narcotics are needed and minimal postop pain d/t the use of what? 4. nasal packing will add to what postop? (AO) 5. avoiding what on extubation? (B) 6. what type of O2 in recovery? (H) 7. should antiemetics be given?

Answer 32

1. gastric contents 2. 30 degrees 3. LAs 4. airway obstruction 5. bucking 6. humidified 7. yes

Question 33

for a venous air embolism, does ETCO2 go up or down?

Answer 33

down

Question 34

Foreign body aspiration: 1. is is the leading cause of accidental death in children less than 1? 2. where is the most common site? (RMB) 3. what are 6 signs of aspiration? (C,C,C,A,T,W) 4. anesthesia technique depends on what 3 things? (AOL, OS, OS)

Answer 34

1. yes 2. right mainstem bronchus 3. choking, coughing, cyanosis, aphonia, tachycardia, wheezing 4. airway obstruction location, object size, obstruction severity

Question 35

Foreign body aspiration level of the larynx: 1. simple laryngoscopy with what forceps? (M) 2. premedicate with what 3 drugs? (G,P,R) 3. what type of induction and maintain what? (I, SV) 4. anticipate what type of airway obstruction? (C)

Answer 35

1. magill 2. glycopyrrolate, pepcid, reglan 3. inhalation induction, spontaneous ventilation 4. complete

Question 36

Foreign body aspiration level of the distal larynx or trachea: 1. GA is required with what allowing the surgeon to use what to extract the foreign body? (SV, RB) 2. what 3 premeds are given? (G,P, R) 3. ventilation will be via what on either the laryngoscope or the bronchoscope? (SP) 4. what are used to remove the item via the eyepiece of the bronchoscope? (F) 5. keep what 3 things high to compensate for the air leak? (O, GF, TV) 6. what mg/kg of decadron can be given to decrease subglottic edema? 7. what med can be given in the PACU to decrease subglottic edema? (RE) 8. what type of maintenance GA can be used?

Answer 36

1. spontaneous ventilation, rigid bronchoscope 2. glycopyrrolate, pepcid, reglan 3. side port 4. forceps 5. oxygen, gas flows, tidal volumes 6. 0.25-1 mg/kg 7. racemic epi 8. TIVA

Question 37

Tonsillectomy and Adenoidectomy: 1. high incidence of what? (AO) 2. short procedure with the desire for rapid what? (A) 3. bloody airway with high incidence of what? (N,V) 4. usual what type of induction in peds? (I) 5. give what premed to peds? (V) 6. what ETT and secured where? 7. give what 2 med types? (O, S) 8. what type of extubation? (A)

Answer 37

1. airway obstruction 2. awakening 3. nausea, vomiting 4. inhalation 5. versed 6. oral RAE, midline 7. opioids, steroids 8. awake

Question 38

bleeding post tonsillectomy: 1. incidence that requires surgical interventions is what % range? 2. what % of postop hemorrhages occur 6 hours after surgery? 3. what % occur within the next 24 hours? 4. a major concern is the pt did what to a large volume of blood before bleeding is discovered? (S) 5. these pts are at a high risk of what on induction? (A) 6. should you empty the stomach before induction? 7. should induction agents be chosen that preserve cardiac stability?

Answer 38

1. 0.3-0.6% 2. 75% 3. 25% 4. swallowed 5. aspiration 6. yes 7. yes

Question 39

cleft lip and palate: 1. intubation is straight forward unless the blade continues to fall into the what? (C) 2. doing what to the cleft helps with intubation? (P) 3. what type of ETT down the center is sufficient? 4. surgeons place what in the tongue to pull it forward and alleviate airway obstruction postop? (S) 5. extubate awake d/t copious amounts of what 2 things? (S, B) 6. avoid what post extubation? (OA) 7. do these pts go to the ICU?

Answer 39

1. cleft 2. packing 3. oral RAE 4. sutures 5. secretion, bood 6. oral airway 7. yes

Question 40

ear surgery: 1. avoid what 1 drug and 1 type of drug? 2. is there a high degree of PONV? 3. what type of technique? (N) 4. can't use nitrous because it can diffuse into the cavity and displace the what? (G) 5. what is being watched for preservation, which does not allow for the use of MRs? 6. what CNs are being watched?

Answer 40

1. nitrous, MRs 2. yes 3. narcotic 4. graft 5. watching for CN preservation 6. 7, 9, 10, 11, 12

Question 41

cochlear implants: 1. electrodes are placed for direct stimulation of what nerve? (A) 2. give what type of med? (A) 3. avoid what type of med? 4. avoid what 3 things? (C, S, B) 5. this is safely performed in infants greater than how many months of age?

Answer 41

1. auditory 2. antiemetics 3. MRs 4. coughing, straining, bucking 5. 6 months

Question 42

dental restoration: 1. majority are done under what type of anesthesia? 2. what type of intubation is needed?

Answer 42

1. GA | 2. nasal

Question 43

radical neck dissection: 1. oropharyngeal and laryngeal compromise what % range of all cancers in the U.S.? 2. more men or women? 3. what % of them are over 60 years old? 4. pts might receive what prior to surgery? (R) 5. tumors tend to be what and to do what easily? (F, B) 6. what is the most frequent surgery? (TL)

Answer 43

1. 3-5% 2. men 3. 75% 4. radiation 5. friable, bleed 6. total laryngectomy

Question 44

total laryngectomy: 1. removal of what bone, the entire what, what cartilage, and 2 or 3 rings of the what? (H, L, C, T) 2. what 3 structures remain? (T, PW, LT) 3. do these pts have a voice? 4. what do this pts breathe via? 5. do these pts have swallowing issues?

Answer 44

1. hyoid bone, entire larynx, cricoid cartilage, trachea 2. tongue, pharyngeal wall, lower trachea 3. no 4. tracheostomy 5. no

Question 45

supraglottic laryngectomy: 1. remove what 3 things? (HB, E, FVC) 2. what 3 things remain? (TVC, CC, T) 3. is voice normal? 4. does aspiration occur occasionally?

Answer 45

1. hyoid bone, epiglottis, false VCs 2. true VCs, cricoid cartilage, trachea 3. yes 4. yes

Question 46

partial laryngectomy: 1. remove one what? (VC) 2. do all the other structures remain? 3. in one word, describe their voice? 4. do these pts have a problem swallowing?

Answer 46

1. vocal cord 2. yes 3. hoarse 4. no

Question 47

radical neck dissection: 1. most airways will be done how? 2. short or long procedures? 3. HOB at what degrees? 4. ICU stay overnight d/t worried about what? (AE) 5. what type of infusion is used? (N)

Answer 47

1. awake 2. long 3. 30 degrees 4. airway edema 5. narcotic infusion

Question 48

what are 5 radical neck dissection complications? (VAE, HI, P, PE, DT)

Answer 48

1. venous air embolism 2. hemodynamic instability 3. pneumo 4. pulmonary edema 5. delirium tremors

Question 49

maxillofacial trauma: 1. what must be maintained during intubation? (MILS) 2. what type of line might be placed to help with controlled hypotension?

Answer 49

1. manual in-line stabilization | 2. art line

Question 50

Le Fort 1: 1. fx of the upper or lower maxilla? 2. separation of what 3 things from the maxilla? (HP, AP, UT) 3. in one word, describe the airway compromise? (M) 4. may be intubated in what 2 ways?

Answer 50

1. lower 2. hard palate, alveolar processes, upper teeth 3. minimal 4. orally, nasally

Question 51

Le Fort 2: 1. in one word, describe the amount of the maxilla that is free floating? (M) 2. pyradial fx from the bridge of the what through the what 2 walls of orbit? (N, M, I) 3. can these pts be nasally intubated?

Answer 51

1. most 2. nose, medial, inferior 3. no

Question 52

Le Fort 3: 1. complete separation of the midface from the what, and extending through what 2 things and what region? (S, O, N) 2. can these pts be nasally intubated?

Answer 52

1. skull, orbits, nasoethmoidal | 2. no

Question 53

what laryngeal muscle does these functions: 1. lateral cricoarytenoid does what to the VCs? 2. posterior cricoarytenoid does what to the VCs? 3. cricothyroid tenses or relaxes the VCs? 4. thyroarytenoid tenses or relaxes the VCs? 5. the transverse arytenoid closes what? 6. the oblique arytenoid controls the sphincters where and decreases what volume? (V, L)

Answer 53

1. adducts 2. abducts 3. tenses (lengthens) 4. relaxes (shortens) 5. glottis 6. vestibule, larynx