7/24/2013

7/24/2013

Answers:

Symptoms of GERD include all of the following except.
A) Halitosis 
B) Ear pain 
C) Cough 
D) Globus 
E) All of the above are symptoms of GERD

What is the main risk factor for esophageal SCC? Adenocarcinoma?

SCC = tobacoo and etoh use as well as chronic ingestion of hot liquids and poor dental hygiene. Adenocarcinoma = GERD

MC Question:

The blood supply to the superior half of the trachea is primarily --- where the blood supply to the inferior half is primarily---
A) Sup. Thyroid, Bronchial Arteries
B) Inf. Thyroid, Bronchial Arteries 
C) Sup. Thyroid, Inf. Thyroid 
D) Sup. Thyroid, Esophageal Artery 
E) Inf. Thyroid, Esophageal Artery

Free Response Questions:
At what external landmark does the innominate artery cross over the trachea?

Quick Facts:
Tracheoinnominate Fistula
-Rare but fatal complication of intubation.
-Due to cuff overinflation or poorly placed tube.
-Dx w/ direct bronchoscopy.
Prevention
-Limited intubation times (>2wks)
-Place trach tube btwn 2-3rd tings.
-Avoid sharp angled tubes.
-Proper tracheostomy technique
Surgical Intervention
-Initial maneuver is to overinflate trach cuff to control bleeding.
-Move directly to OR.
-Can also manually compress artery against sternum.
-Sternotomy is suggested for exposure, ligate artery above and below fistula.
-Remove damaged segment and interpose strap muscle btwn airway and artery.
Prognosis
-25-50% survival rate.