8/30/2013

8/30/2013

Answers:

An adult patient undergoes polysomnography to assess possible OSA. They are found to have an AHI of 25 which categorizes their OSA as...?
A) Mild 
B) Moderate 
C) Severe 
D) They do not meet criteria for OSA

OSA = AHI > or equal to 5 events/h.
-5-15 = mild
-15-30 = moderate
- >30 = severe

What percentage of adult men have an AHI > 5?

25%of men have an AHI>5, 9% of adult women have an AHI>5.

MC Question:

Risk factors for adult OSA include all of the following except.
A) African American 
B) Native American 
C) Male Gender 
D) Obesity

Free Response Question:
Describe the pathway by which OSA causes nocturia/enuresis?

Quick Facts:
CPAP:
-1st line recommended therapy.
-decreases snoring, apneas and daytime sleepiness.
-decreased accidents.
-Recommended for all with AHI>30 and for those >5 w/ symptoms.
-90-95% effective, but dependent on pt compliance, 85% compliance @ 6 months.
-side effects include claustrophobia, headache, rhinitis, facial/nasal irritation, aerophagia and social difficulties.

8/29/2013

8/29/2013

Answers:

What stage of sleep is associated with K complexes?

A) Stage I 

B) Stage II 

C) Stage III 

D) Stage IV 

E) REM

-Stage I = increased theta wave, decreased alpha waves.
-Stage II = K-complexes/spindles
-Stage III/IV= lots of delta waves.

What is the definition of apnea in an adult? In a child?

In adults, Apnea = at least 10 seconds w/ no air flow via mouth or nose. 
In children there is no time requirement, Apnea = no air flow via mouth or nose.

MC Question:

An adult patient undergoes polysomnography to assess possible OSA. They are found to have an AHI of 25 which categorizes their OSA as...?
A) Mild 
B) Moderate 
C) Severe 
D) They do not meet criteria for OSA

Free Response Question:
What percentage of adult men have an AHI > 5?

Quick Facts:
-OSA Risk Factors:
-Obesity--> 3 fold increase w/ 1 SD of BMI increase.
-Male Gender
-Native Americans
-Acromegaly

8/28/2013

8/28/2013

Answers:

REM sleep makes up ---% of a typical night's sleep.
A) 5% 
B) 15% 
C) 25% 
D) 50% 
E) 65%

25% of sleep is typically in the REM phase.

How long does a typical sleep cycle last? How many sleep cycles per night does an average adult have?

3-4 sleep cycles per night, each cycle last 90-120 minutes.

MC Question:

What stage of sleep is associated with K complexes?

A) Stage I 

B) Stage II 

C) Stage III 

D) Stage IV 

E) REM

Free Response Question:
What is the definition of apnea in an adult? In a child?

Quick Facts:
-Apnea Hypopnea index (AHI) = # of apneas and hypopneas per hr of sleep time (min 2 hrs)
-Controversial, does not reflect absolute # of episodes, duration or distribution of events.
-OSA = AHI > or equal to 5 events/h.
-5-15 = mild
-15-30 = moderate
- >30 = severe

8/27/2013

8/27/2013

Answers:

Ampullopetal flow in the semicircular canals causes the posterior canal to ---, the horizontal canal to---and the superior canal to---their firing rate.
A) increase, increase, increase
B) decrease, decrease, decrease 
C) decrease, increase, increase 
D) increase, increase, decrease
E) decrease, increase, decrease

The horizontal canal increases firing rate when stereocilia bend toward the vestibule and decrease firing rate when they bend away. It is the opposite with the posterior and superior canals.

Arrange the following in order from the cochlea to the brain: auditory cortex, hair cells, medial geniculate bodies, afferent nerves, inferior colliculi, cochlear nuclei, lateral lemnisci, superior olive complexes

Hair cells-> afferent nerves-> cochlear nuclei-> superior olive complexes-> lateral lemnisci->inferior colliculi->medial geniculate bodies->auditory cortex

MC Question:

REM sleep makes up ---% of a typical night's sleep.
A) 5% 
B) 15% 
C) 25% 
D) 50% 
E) 65%

Free Response Question:
How long does a typical sleep cycle last? How many sleep cycles per night does an average adult have?

Quick Facts:
NREM Sleep Stages:  
-Stage I = transition phase, 2-5%, increased theta wave, decreased alpha waves.
-Stage II = 50% of sleep, K-complexes/spindles, decreased muscle tone/awareness.
-Stage III/IV=deep sleep, lots of delta waves, ~20% of sleep. Most restful sleep. Less w/ age.

8/26/2013

8/26/2013

Answers:

Above what decibel does the stapedius muscle contract in order to decrease motion of the ossicles?

A) 20dB 
B) 40dB 
C)60dB 
D)80dB 
E) 100dB

This is referred to as the acoustic reflex.

Within the cochlea, Reissner's membrane separates---from---, whereas the basilar membrane separates--- from ---.

Reissner's membrane separates the scala vestibuli from the scala media whereas the basilar membrane separates the scala media from the scala tympani.

MC Question:

Ampullopetal flow in the semicircular canals causes the posterior canal to ---, the horizontal canal to---and the superior canal to---their firing rate.
A) increase, increase, increase
B) decrease, decrease, decrease 
C) decrease, increase, increase 
D) increase, increase, decrease
E) decrease, increase, decrease

Free Response Question:
Arrange the following in order from the cochlea to the brain: auditory cortex, hair cells, medial geniculate bodies, afferent nerves, inferior colliculi, cochlear nuclei, lateral lemnisci, superior olive complexes

Quick Facts:
Ampullopetal Flow = toward ampulla 
Ampullofugal Flow = away from ampulla

8/19/2013

8/19/2013

Answers:

The medial 2/3rd of the EAC is --- whereas the lateral 1/3rd is ---
A) Free of hairs; cartilaginous 
B)Free of hairs; Bony 
C)Has hair follicles; cartilaginous 
D)Has hair follicles; Bony 
E) Has sebaceous glands; cartilaginous 
F) Has sebaceous glands; bony

The medial 2/3rds of the EAC is bony and does not have hair follicles whereas the lateral 1/3rd of the EAC is cartilaginous and has hair follicles as well as ceruminous and sebaceous glands.

What are the four divisions of the temporal bone?

Squamous, petrous, tympanic and mastoid segments

MC Question:

Above what decibel does the stapedius muscle contract in order to decrease motion of the ossicles?

A) 20dB 
B) 40dB 
C)60dB 
D)80dB 
E) 100dB

Free Response Question:
Within the cochlea, Reissner's membrane separates---from---, whereas the basilar membrane separates--- from ---.

Quick Facts:
Neural Pathway of Hearing:
Cochlea-->Hair cells-> afferent nerves-> cochlear nuclei-> superior olive complexes-> lateral lemnisci->inferior colliculi->medial geniculate bodies->auditory cortex

8/16/2013

8/16/2013

Answers:

---is an intraop complication, --- is early postop complication and --- is a late postop complication of airway reconstruction surgery.
A) Pneumomediastinum, vocal cord paralysis, ETT dislodgement B) Tracheocutaneus fistula, alar necrosis, granulation tissue formation 
C) ETT dislodgement, restensosis, pneumothorax 
D) Pneumothorax, pneumothorax, Subcutaneous emphysema 
E) Vocal Cord Paralysis, Atelectasis, Inability to decannulate

Care should be taken to avoid damage to RLN to prevent vocal cord paralysis intraop, Atelectasis is a common early postop complication due to prolonged intubation, sedation and paralysis and inability to decannulate is the most feared late postop complications of airway reconstruction surgery.

When performing supraglottoplasty for laryngomalacia, the three most common techniques include removing redundant---, releasing foreshortened --- and shaving down ---.

1) arytenoid mucosa 
2) aryepiglottic folds 
3) lateral edges of epiglottis

MC Question:

The medial 2/3rd of the EAC is --- whereas the lateral 1/3rd is ---
A) Free of hairs; cartilaginous 
B)Free of hairs; Bony 
C)Has hair follicles; cartilaginous 
D)Has hair follicles; Bony 
E) Has sebaceous glands; cartilaginous 
F) Has sebaceous glands; bony

Free Response Question:
What are the four divisions of the temporal bone?

Quick Facts:
Anatomy of the Cochlea: 
-3 compartments: Scala vestibuli, scala media and scala tympani.  
-Reissners membrane divides the vestibuli and media.  
-Basilar membrane divides media from tympani.  
-Vestibuli and tympani are filled with perilymph (chambers end w/ "I" and have per"I"lymph).  
-Media is filled with endolymph.

8/15/2013

8/15/2013

Answers:

The operation of choice to treat children with laryngomalacia that require surgical intervention is?
A) Balloon Laryngoplasty 
B) Anterior Cricoid Split 
C)Tracheotomy 
D) Supraglottoplasty

Supgraglottoplasty is the primary procedure used for children who require surgical intervention for laryngomalacia.

Cricotracheal resection used to be used only for patients who failed laryngotracheal reconstruction with grafting, however, currently is is being used as first line treatment in what group?

Those with severe (>70%) luminal obstruction.

MC Question:

---is an intraop complication, --- is early postop complication and --- is a late postop complication of airway reconstruction surgery.
A) Pneumomediastinum, vocal cord paralysis, ETT dislodgement B) Tracheocutaneus fistula, alar necrosis, granulation tissue formation 
C) ETT dislodgement, restensosis, pneumothorax 
D) Pneumothorax, pneumothorax, Subcutaneous emphysema 
E) Vocal Cord Paralysis, Atelectasis, Inability to decannulate

Free Response Question:
When performing supraglottoplasty for laryngomalacia, the three most common techniques include removing redundant---, releasing foreshortened --- and shaving down ---.

Quick Facts:
Prognosis with Regards to Airway reconstruction
-Dependent on initial severity of lesion, comorbidities and surgeon skill.
-Usually decannulation occurs in 80-90% of pts but often requires multiple procedures.

8/14/2013

8/14/2013

Answers:

Which of the following is false regarding single stage airway expansion surgery?
A) Useful for Grade II stenosis 
B) Useful for Grade III stenosis 
C) It has become increasingly popular 
D) May require significant sedation postop 
E) May require administering paralytics postop

-Single Stage: increasingly popular.
-Trach is removed at expansion surgery w/ 7-10 days of postop stenting w/ ETT.
-Not appropriate for those w/ Grade III/IV stenosis or poor pulm reserve.
-Requires prolonged hospitalization in ICU and immobilization.
-May require sedation/paralysis in younger kids.

What specific population was the anterior cricoid split developed for?

Premature infants without confounding heart or lung comorbidities who weighed at least 1500g. Anterior cricoid split was developed for them in an attempt to avoid tracheotomy.

MC Question:

The operation of choice to treat children with laryngomalacia that require surgical intervention is?
A) Balloon Laryngoplasty 
B) Anterior Cricoid Split 
C)Tracheotomy 
D) Supraglottoplasty

Free Response Question:
Cricotracheal resection used to be used only for patients who failed laryngotracheal reconstruction with grafting, however, currently is is being used as first line treatment in what group?

Quick Facts:
Complications of Airway Reconstruction Surgery
Intraop:
-Pneumothorax (when harvesting costal cartilage)
-Vocal fold paralysis
Early Postop:
-Endotracheal tube/stent displacement
-SubQ emphysema, pneumothorax, pneumomediastinum.
-secure ETT/stents well to avoid.
-Atelectasis
-due to prolonged intubation, sedation, paralysis and narcotic withdrawal.
-must balance risk of stent dislodgement with risk of sedation/paralysis.
-Prolonged nasal intubation can because alar necrosis, inspect well daily to avoid.
Late Postop:
-Granulation tissue formation and restenosis:
-occurs at tip of stent
-glottic or supraglottic stenosis
-cartilage grafts can prolapse into airway
-can avoid if postop endoscopy performed regularly.
-Problems w/ voice quality
-can worsen postop due to ant. commissure asymmetry, glottic web formation or vocal fold scarring.
-intraop avoid incision of ant. commissure.
-can consider reconstruction w/ keel placement.
-postop voice therapy is indicated.
-Tracheocutaneous fistula
-Suprastomal collapse
-Arytenoid prolapse and supraglottic collapse
-partial arytenoidectomy may be needed.
-Inability to decannulate
-more common in Grades III and IV.

8/13/2013

8/13/2013

Answers:

A laryngeal cleft that includes a complete defect through the cricoid cartilage is classified as Type ---?
A) I 
B) II 
C) III 
D) IV

-Type 1 = supraglottic interarytenoid region defect not below true folds
-Type 2=cleft extends below true folds
-Type 3=complete defect of cricoid cartilage
-Type 4= extends into posterior wall of thoracic trachea.

What are three surgical options for treating subglottic stenosis?

-Tracheotomy
-Endoscopic management w/ laser and dilation (for mild/moderate)
-Airway expansion surgery (for severe)

MC Question:

Which of the following is false regarding single stage airway expansion surgery?
A) Useful for Grade II stenosis 
B) Useful for Grade III stenosis 
C) It has become increasingly popular 
D) May require significant sedation postop 
E) May require administering paralytics postop

Free Response Question:
What specific population was the anterior cricoid split developed for?

Quick Facts:
Laryngomalacia
-Most patients can be managed conservatively.
-Rarely surgery is needed:
-cardiac/pulm compromise
-failure to thrive
-Supraglottoplasty is operation of choice., trach is SGP fails.
-Always eval for GERD before (80% comorbid rates)
-3 most common techniques are:
-shaving down lateral edges of epiglottis
-releasing foreshortened aryepiglottic folds
-removing redundant arytenoid mucosa
-Careful to avoid extra laser damage as scar formation and postop aspiration is a risk.
-Short course of postop steroids often given

8/12/2013

8/12/2013

Answers:

The second most common cause of neonatal stridor is?

A) Vocal Fold Paralysis 

B) Laryngomalacia 

C) Laryngeal Web 

D) Acquired subglottic stenosis secondary to intubation

Vocal fold paralysis accounts for 10% of neonatal stridor. Laryngomalacia accounts for the majority of the rest whereas laryngeal webs and subglottic stenosis are more unusual causes of stridor.

What is the most common etiology of neonatal vocal cord paralysis?

Neonatal vocal fold paralysis is most commonly secondary to hydrocephalus (often due to malformations such as Arnold Chiari). Intravertebral contents pushing through the jugular foramen stretches the vagus.

MC Question:

A laryngeal cleft that includes a complete defect through the cricoid cartilage is classified as Type ---?
A) I 
B) II 
C) III 
D) IV

Free Response Question:
What are three surgical options for treating subglottic stenosis?

Quick Facts:
Anterior Cricoid Split
-Done to avoid tracheotomy in specific populations: premature infants less than 1500g w/o confounding cardiac/pulm and ant. subglottic stenosis on bronch.
-Ant cricoid is divided midline and extended superiorly through lower third of thyroid and inferiorly through 1st/2nd tracheal rings. ETT is replaced with larger diameter tube used to stent for 7-10 days.
-Give steroids 1mg/kg/d for 5 days postop
-A fibrous band should form at incision site causing airway enlargement even after stent removal.
-70-80% success rate.
-Concern that procedure may disrupt future cartilage growth, has not been substantiated.

8/9/2013

8/9/2013

 

Answers:

After retrieving a peanut from an 8 year old's airway the surgeon notices a significant amount of edema and decides to give dexamethasone. What dose should be administered to the patient?

A) .1-.5 mg/kg 

B) .5-1.0 mg/kg 

C) 1.0-1.5mg/kg 

D) 1.5-3.0mg/kg 

E) Dexamethasone is not appropriate in this situation.

Decadron should be given at a dose of 0.5-1.0 mg/kg after retrieval of airway foreign bodies if significant edema is present .

Why should airway foreign bodies be retrieved while the patient is spontaneously breathing opposed to administering a paralytic and ventilating the patient?

Retrieving an object while patient is spontaneously breathing offers several advantages:
-makes passage of bronchoscope easier
-prevents distal migration of foreign body during positive pressure ventilation
-takes advantage of increased cross sectional area present during inspiration

MC Question:

The second most common cause of neonatal stridor is?

A) Vocal Fold Paralysis 

B) Laryngomalacia 

C) Laryngeal Web 

D) Acquired subglottic stenosis secondary to intubation

Free Response Question:
What is the most common etiology of neonatal vocal cord paralysis?

Quick Facts:
Laryngeal Clefts
-from failure of fusion of tracheoesophageal septum.
-Type 1 = supraglottic interarytenoid region defect not below true folds
-Type 2=cleft extends below true folds
-Type 3=complete defect of cricoid cartilage
-Type 4= extends into posterior wall of thoracic trachea.

8/8/2013

8/8/2013

 

Answers:

How quickly can button batteries can cause mucosal erosion once ingested?

A) immediately on ingestion 

B) within 30 minutes 

C) within 1 hour 

D) within 3 hours 

E) within 6 hours

Button batteries can cause mucosal erosion within 6 hours which is why it is important to find out when the ingestion occurred and removal should be performed ASAP.

Under what circumstances is it appropriate to observe a patient who has ingested a coin for possible spontaneous passage?

An asymptomatic older kid w/ distal or midesophageal coin which has been there for less than 24hrs can be observed for 8-16 hrs for spontaneous passage. In young kids/coin present >24hrs/sharp/caustic foreign body one should intervene as soon as possible and not delay treatment by observing.

MC Question:

After retrieving a peanut from an 8 year old's airway the surgeon notices a significant amount of edema and decides to give dexamethasone. What dose should be administered to the patient?

A) .1-.5 mg/kg 

B) .5-1.0 mg/kg 

C) 1.0-1.5mg/kg 

D) 1.5-3.0mg/kg 

E) Dexamethasone is not appropriate in this situation.

Free Response Question:
Why should airway foreign bodies be retrieved while the patient is spontaneously breathing opposed to administering a paralytic and ventilating the patient?

Quick Facts:
Airway Foreign Body Prognosis
-Most have full recovery.
-Worst outcome is when there is delay in diagnosis.

8/7/2013

8/7/2013

 

Answers:

A foreign body aspiration that is present for a significant amount of time can cause a chronic cough and be misdiagnosed as what?

A) Pneumonia 

B) Asthma 

C) Croup 

D) All of the above 

E) None of the above, foreign bodies present acutely.

If a foreign body is aspirated it may not always present with acute airway symptoms and can cause a chronic cough and/or wheezing which is commonly misdiagnosed as asthma, pneumonia or croup. One must have a high index of suspicion if a patient, with a risk factor for aspiration, with one of these disease does not respond to appropriate therapy.

If a foreign body is aspirated it may cause a ball-valve effect in the bronchi which leads to --- or it can completely obstruct the bronchi leading to ---.

1) hyper expansion 2) lung collapse

MC Question:

How quickly can button batteries can cause mucosal erosion once ingested?

A) immediately on ingestion 

B) within 30 minutes 

C) within 1 hour 

D) within 3 hours 

E) within 6 hours

Free Response Question:
Under what circumstances is it appropriate to observe a patient who has ingested a coin for possible spontaneous passage?

Quick Facts:
With regards to rigid endoscopy removal of foreign body:

-retrieve object while patient is spontaneously breathing if possible
-makes passage of bronchoscope easier
-prevents distal migration of foreign body during + pressure ventilation
-takes advantage of increased cross sectional area during inspiration
-careful to avoid dropping foreign body back in airway once retrieved.