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80 Cards in this Set
- Front
- Back
When do they repair a Cleft Palate and a Cleft Lip? |
Cleft Lip 3-6 months Cleft Palate 9-18 months |
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Pierre Robin Syndrome |
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What is the Clinical Triad of Pierre Robin Syndrome? |
1. Retrognathia (receding jaw, in relation to forehead) or Micrognathia
2.Glossoptosis (backward & downward displacement of the tongue) 3.Airway obstruction |
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What are the four syndromes associated with Pierre Robin Syndrome? |
•Fetal alcohol syndrome
•Stickler syndrome •Treacher Collins syndrome •Velocardiofacial syndrome |
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What is Mandibular Distraction and how is it used to treat Pierre Robin Syndrome |
•Distraction is performed at a rate of 2mm/day for 5 days, followed by 1mm/day as needed to achieve a 2mm overjet
•After 5 days and approx. 6-10mm distraction, patient may be extubated Extubated in OR in case of Airway emergency Distractors stay in place for 12-16 weeks to allow consolidation of new bone |
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What are the important considerations for Pierre Robin Syndrome? |
Inteligence is normal May have hearing loss Airway obstruction and difficulty of intubation usually improve with age. |
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Treacher Collins Syndrome |
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What characterizes Treacher Collins Syndrome? |
•Poorly developed supraorbital ridges•Ophthalmic abnormalities •Ear deformities •Hearing loss •Cleft lip or palate
•Macrostomia (unusually large mouth)•Malocclusion of the teeth•Maxillary hypoplasia •Mandibular hypoplasia •Midface hypoplasia |
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What is Choanal atresia and Glossoptosis? |
•Choanal atresia - narrowing or blockage of the nasal airway by tissue
•Glossoptosis - downward displacement or retraction of the tongue |
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When is the majority of the reconstructive surgery done for Treacher Collins Syndrome? |
Occurs during childhood or adolescence when the cranio-orbital zygomatic body development is nearly complete
Direct laryngoscopy becomes more difficult with increasing age |
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Goldenhars Syndrome |
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What makes Goldenhars syndrome difficult to manage? |
Difficult Intubation (airway anomolies, Sm mouth openning) Difficult Mask Ventilation Difficult airway gets worse with age |
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What is key for anesthetic management for all three Cranofacial abnormalities? |
Maintain spontaneous respirations (until airway secured) no paralytics Decadron Acetaminophen/Fentanyl Extubate when awake & prepared to reintubate |
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What does the OMENS acronym stand for related to Goldenhars syndrome? |
O-Orbit M-Mandible E-Ear N-Facial Nerve S-Soft Tissue Unilateral |
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Describe the anatomy of the outer, middle, and inner ear: |
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What are the Ossicles? |
•malleus (or hammer) long handle attached to the eardrum
•incus (or anvil) the bridge bone between the malleus and the stapes •stapes (or stirrup) the footplate; the smallest bone in the body |
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What nerve can be affected by surgeries of the ear? |
Facial Nerve |
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What is a Myringotomy or BMT? |
Ear Tubes (Bilateral Myringotomy Tubes) Can start with NO2 induction (off for the case) Intranasal Fentanyl |
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What is a Tympanoplasty, and what can be used for it? |
Repair of the ear drum, can use cartilage from the Tragus. May include ossicular reconstruction |
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What is a Labyrinthectomy? |
Complete removal of the inner ear. Used to treat Meniere's Disease |
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How long does it take for a cochlear implant to be effective? |
1-2 months post op to fine tune the input |
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What are special considerations for ear surgeries? |
•Table turned 90-180 degrees away will be from anesthesia (AIRWAY, monitoring considerations)•TIVA
•N2O usually avoided •No paralysis (facial nerve identification) •Deep Extubation •PONV prevention |
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How long before the placement of a tympanic membrane graft does NO2 need to be turned off? |
30 minutes |
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What are the two primary functions of the nasal cavity? |
Olfaction (smell) Filtration |
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What are the four parts of the nasal anatomy? |
Nasal Septum Turbinates Adenoids Paranasal Sinuses |
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What is the first line of defense (for Kids) to trap and kill Micro-organisms? |
The adenoids |
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Where are the four paranasal sinuses? |
•Maxillary: in the cheekbones on either side of the nose
•Ethmoid (6-10): beside the upper nose, between the eyes •Sphenoid (1-2): behind the nose, in the center of the skull, surrounded by pituitary •Frontal: lower forehead above the nose |
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A nose bleed from which area is life threatening (Woodriff Area, Kisselbach Area)? Which area is responsible for 80% of nose bleeds? |
Woodriff area is a life threatening bleed (Sphenopalatine artery (from the maxillary) Anterior ethmoidal artery(from the opthalmic)) Kisselbach area is responsible for 80% of nose bleeds. |
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What nerve innervates the nose, and is it sensory, motor, or both? |
Trigeminal-sensory |
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What is Samter's Triad? |
Nasal Polyps ASA allergy Asthma Likely caused by COX pathway (Cyclooxygenase Pathway) |
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What sinus is used to access the pituitary gland in pituitary surgeries? |
Sphenoid Sinuses |
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What are pre-op, intra-op, and post-op implications of sinus surgeries? |
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What are the six muscles of the eye? |
4 rectus muscles (superior, inferior, lateral, medial) 2 Oblique muscles (superior, inferior) |
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What is a Trabeculectomy? |
Trabecular meshwork - mesh-like drainage canals all around the iris responsible for draining aqueous humor from the eye. Used to treat glaucoma |
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What is a Radioactive plaque placement used to treat? What are anesthetic considerations for this procedure? |
Treatment of melanoma LMA (usually placed on Monday and removed on Friday) Sevo at a MAC of 1.5 Propofol infusion PSV-PRO |
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What is a Dacryocystorhinostomy? |
Restores the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct does not function due to blockage.
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What do you need to have prepared and consider when doing a scleral buckle? |
Have Glyco and Atropine ready, Deep extubation to avoid coughing, limit fluids, antiemetics |
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Can you use NO2 with retinal cases? |
No, surgeons dont know if they will use air bubble. |
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What is Enucleation, Evisceration, and Exenteration |
Enucleation Evisceration-removing all intraocular contents Exenteration-all orbital tissue, often including surrounding orbital bone and adjacent sinuses |
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Why do you avoid Ketamine and Succinylcholine with foreign body removal of the eye? |
They increase IOP. |
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What is a Blepharoplasty? |
Surgery of the eyelid (lift) Small risk of blindness from bleeding May not be able to close eyelids when sleeping |
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What is the Oculocardiac Reflex (OCR)? |
Decrease in heart rate associated with traction on the extraocular muscles or compression of the eyeball
administer atropine 0.007mg/kg, it is eventually self limiting |
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What nerves conduct the Oculocardiac Reflex (afferent and efferent) |
Afferent-Trigeminal nerve (V) Efferent-Vagus nerve (X) |
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What nerves are blocked in a retrobulbar block? |
II, III, IV, V, VI Blocked by injecting 6-10 cc of Lidocaine/Bupivicaine |
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What is the most common complications of a retrobulbar block? |
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If patient has an air bubble placed for and Retinal procedure what is the timeframe to avoid NO2? |
5 days for Air bubble 10 days for sulfur hexafluoride 30 days for perfluoropropane |
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What are anesthetic considerations for open globe surgeries? |
Deep anesthesia 1.5 MAC Sevo ETT for all open Globe cases Ensure appropriate paralysis Use sevo for deep extubation Strongly consider Remifentanyl gtts |
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What are contraindications for a Nasal Intubations? |
LaFort II and III- may have a possible basilar skull fracture. |
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What do you need to do before nasal intubation, and what sizes do you use? |
Afrin spray Male 7 (27-29 cm) Female 6 (25-27) Tall patients may need to use a regular tube with a bend connector |
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What is an ODONTECTOMY? |
Teeth removal. Emergence Suction well, oral and gastric Extubate when fully awake |
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Odontectomy with Downs syndrome special consideration? |
Small oropharynx with large tongue & tonsilsAtlanto-occipital instability
Co-existing cardiac disease Potential for bradycardia upon induction |
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How should you treat bleeding tonsils? |
As an emergency |
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What necessitates an awake fiberoptic intubation? |
Inspiratory Stridor at rest. |
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LaFort I |
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What are the guidelines for hypotensive technique? |
Keep MAP 50-60 in normotensive patients For HTN do not go below 20% of baseline |
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When you have stridor at rest, what percentage of occlusion is suspected? |
Greater than 50-60% |
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What are considerations for direct laryngoscopy? |
Suspension results in severe sympathetic stimulation-use fast acting narc Need vocal cord paralysis-use fast acting paralytic |
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What is involved in a panendoscopy? |
triple endoscopy
•Laryngoscopy •Bronchoscopy •Esophagoscopy |
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What is important with bronchoscopies? |
Maintain spontaneous respirations Use topical analgesics |
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What is important with rigid bronchoscopy? |
Patient cannot move, could cause significant trauma. |
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What is a Microlaryngeal Tube (MLT)? |
A smaller diameter tube with a bigger cuff |
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How do you perform low frequency Jet ventilation? |
Connect pressure reducing valve to wall O2 Hand ventilate at a rate of 10-30 I:E ratio of 1:3 Exhalation is passive (risk of breath stacking) |
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What is Intermittent Apnea Technique? |
Periods of ventilation, extubation, periods of apnea, reintubation
First muscles to come back are the cords & diaphragm may need to redose paralytic even with 0/4 twitches. |
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What do you fill the balloon of a laser safe tube with? |
Saline (has a blue dye to see if perforated) |
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What is the fire triangle in ENT surgery? |
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What steps should be taken to prevent an airway fire? |
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Which nerve supplies all the intrinsic muscles of the larynx except cricothyroid and sensation to larynx below vocal cords? |
Recurrent Laryngeal Nerve |
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Which provides motor innervation to the crycothyroid muscle and sensory above the vocal cords? |
Superior Laryngeal Nerve |
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What is the Pneumonic to remember what the only muscle pulls the vocal cords apart is? |
PCA-Posterior Crycoarytenoids |
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How many levels of lymph nodes are there? |
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Where is the Stellae Ganglion Located? |
At the level of C7, anterior to the transverse process, superior to the first rib, below subclavian artery. |
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What does injury to the stellae ganglion cause? |
Horners syndrome-Decreased sweating, drooping eyelid, constricts pupil, difficulty swallowing, and hoarseness |
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Where is the Carotid sinus located? |
at the level of C3-4. |
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What level is the Larynx located in adults and infants? |
Adults C6 Infants C4 |
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What are cardiovascular complications of a radical neck dissection? |
Bradycardia Wide swings in BP Dysrhythmia Sinus Arrest Prolonged QT |
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What are Respiratory Complications of Neck Dissection, signs, and treatments? |
Air emboli-Risk when wound is above heart Signs-Decreased (ETCO2, CO, SPO2) Sudden hypotension, Increase PAP Interventions-Flood Field, 100% O2, Left Lateral Decubitus position, Support Pressure |
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What is the most common cause of airway obstruction within 20 hours of neck surgery? |
Hemorrhage with tracheal compression |