Tracheostomy Quiz

The most common indication for tracheostomy in ICU patients is:

• Upper airway obstruction

• Prolonged mechanical ventilation

• Aspiration prevention

• Severe obstructive sleep apnea

• Tracheal stenosis

Answer explanation

The most common indication for tracheostomy in ICU patients is prolonged mechanical ventilation, as it allows for long-term airway management and facilitates weaning from ventilatory support.

A patient with bilateral vocal cord paralysis presents with stridor. The definitive airway management is:

• Endotracheal intubation

• Cricothyrotomy

• Emergency tracheostomy

• Oxygen therapy

• Heliox inhalation

Answer explanation

Emergency tracheostomy is the definitive airway management for bilateral vocal cord paralysis with stridor, as it provides immediate access to the airway when intubation is not feasible or effective.

Which of the following is NOT an early complication of tracheostomy?

• Hemorrhage

• Pneumothorax

• Subcutaneous emphysema

• Tracheal stenosis

• Tube displacement

Answer explanation

Tracheal stenosis is a late complication of tracheostomy, occurring over time due to scar formation. In contrast, hemorrhage, pneumothorax, subcutaneous emphysema, and tube displacement are early complications.

The most common late complication of tracheostomy is:

• Pneumothorax

• Tracheal stenosis

• Hemorrhage

• Tube displacement

• Subcutaneous emphysema

Answer explanation

Tracheal stenosis is the most common late complication of tracheostomy due to prolonged pressure and irritation on the trachea, leading to scar tissue formation and narrowing of the airway.

Smoke inhalation injury may necessitate tracheostomy due to:

• Bronchospasm

• Laryngeal edema

• Tracheomalacia

• Pulmonary embolism

• Pneumonia

Answer explanation

Laryngeal edema is a common complication of smoke inhalation that can obstruct the airway, making tracheostomy necessary to secure breathing. Other options like bronchospasm and tracheomalacia are less directly related.

Bilateral recurrent laryngeal nerve injury leads to:

• Aphonia

• Stridor

• Dysphagia

• Aspiration pneumonia

• Tracheomalacia

Answer explanation

Bilateral recurrent laryngeal nerve injury can lead to stridor due to impaired vocal cord function, causing airway obstruction. Aphonia and dysphagia may occur, but stridor is the most direct result of this nerve injury.

Intracranial causes of tracheostomy include:

• Brainstem infarction

• Cerebellar hemorrhage

• Subdural hematoma

• Migraine

• Epilepsy

Answer explanation

Brainstem infarction can lead to respiratory failure due to its impact on the brain's control of breathing, making tracheostomy necessary. Other options like migraine and epilepsy do not typically require this intervention.

Which laryngeal condition most commonly requires tracheostomy?

• Laryngomalacia

• Acute epiglottitis

• Laryngeal carcinoma

• Vocal cord nodules

• Laryngitis

Answer explanation

Laryngeal carcinoma often leads to airway obstruction due to tumor growth, making tracheostomy necessary for maintaining breathing. Other conditions like laryngomalacia and laryngitis typically do not require such intervention.

Ludwig’s angina may require tracheostomy due to:

• Trismus

• Tongue swelling

• Airway obstruction

• Dysphagia

• Pain

Answer explanation

Ludwig’s angina can lead to significant swelling of the tissues in the mouth and neck, which may cause airway obstruction. This is the primary reason a tracheostomy may be necessary to secure the airway.

A mediastinal mass compressing the trachea may necessitate:

• Cricothyrotomy

• Tracheostomy

• Endotracheal intubation

• Laryngectomy

• Bronchotomy

Answer explanation

A tracheostomy is indicated when a mediastinal mass compresses the trachea, as it provides a direct airway access below the obstruction, allowing for ventilation and oxygenation, unlike other options.