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WorksheetsEar Anatomy and Microtia Repair Anesthesia
Total questions: 30
Worksheet time: 15mins
In the labeled ear diagram, which sequence correctly lists the three ossicles of the middle ear from lateral to medial?
Stapes, malleus, incus
Malleus, incus, stapes
Incus, stapes, malleus
Malleus, stapes, incus
During microtia repair using autologous cartilage, which ribs are typically harvested for the graft?
1st–3rd ribs
4th–6th ribs
6th–8th ribs
8th–10th ribs
A young, otherwise healthy 9-year-old is scheduled for microtia reconstruction with rib graft harvest and later ear elevation. Which plan best reflects the described two-stage procedure and typical intraoperative positioning?
Single operation; supine with head neutral for all steps
Two operations months apart; head rotated away from the operative ear
Three operations in one week; sitting position for graft harvest
Two operations the same day; prone for ear reconstruction
Single operation; lateral decubitus for rib harvest and ear creation
In tympanoplasty, the operating table is commonly turned 180 degrees. What is the primary anesthetic implication of this positioning change that requires planning?
Loss of access to the airway
Risk of venous air embolism
Inability to monitor temperature
Reduced IV access to injection ports
Which strategy best minimizes coughing and bucking during emergence from anesthesia in tympanoplasty to avoid graft displacement?
Administer IV lidocaine, a narcotic, or small-dose propofol near emergence
Increase inspired oxygen to 100% early in the case
Use high-dose epinephrine infiltration
Apply positive pressure ventilation with high peak pressures
For tympanoplasty, minimizing intraoperative bleeding is important. Which anesthetic action from the options supports this goal?
Controlled hypotension when appropriate and use of local anesthetic with epinephrine
Maintaining hypertension to perfuse the graft
Avoiding all vasoconstrictors
Routine deep extubation in all patients
Tympanomastoidectomy often requires facial nerve monitoring. What anesthetic adjustment is recommended when this monitoring is used?
Avoid neuromuscular blocking drugs
Use continuous neuromuscular blockade
Switch to total intravenous anesthesia with N2O
Place the patient under regional anesthesia only
In Functional Endoscopic Sinus Surgery (FESS), which anesthetic strategy best helps decrease intraoperative blood loss while maintaining patient safety?
Keeping systolic blood pressure in the high-normal range and placing patient flat
Using vasoconstrictors such as oxymetazoline or phenylephrine and elevating the head of bed 15 degrees
Avoiding vasoconstrictors in all patients and lowering head of bed
Hyperventilating to reduce CO2 and raising systolic blood pressure
A patient on beta blockers presents for FESS. Vasoconstrictors (alpha agonists) are planned. Which risk should the anesthesia provider consider when using these agents in this patient population?
Refractory hypotension due to beta blockade leading to bronchospasm
Hypertension caused by alpha agonists potentially precipitating pulmonary edema and cardiac failure
QT prolongation leading to torsades de pointes
Adrenal suppression resulting in adrenal crisis
All are appropriate anesthetic management considerations for a tympanoplasty EXCEPT:
Avoid the use of nitrous oxide to prevent middle ear pressure buildup
Consider controlled hypotension to minimize bleeding
Perform a deep extubation to avoid coughing and graft displacement
Use nitrous oxide during emergence to facilitate faster wake-up
Which patient characteristic is commonly represented in the population undergoing endoscopic airway surgery?
Young athletes with no comorbidities
Elderly individuals and those with tobacco or alcohol abuse
Only pregnant patients without respiratory issues
Exclusively patients with neurologic disease
For maintenance of anesthesia in endoscopic airway surgery when no vocal cord movement is desired, which plan aligns with the guidance?
Inhalational-only technique with no neuromuscular blockers
Total intravenous anesthesia with succinylcholine infusion titrated to twitch height
Regional anesthesia with no airway devices
Nitrous oxide sedation only
Which ventilation approach is described as allowing the surgeon to operate under apneic conditions until desaturation, followed by brief intubation to restore oxygen saturation?
Jet ventilation through a sideport
Spontaneous ventilation through a sideport
Intermittent apneic technique
Continuous positive airway pressure via face mask
A surgeon needs superficial tissue penetration with minimal risk of retinal injury. Which laser choice aligns with these goals?
Nd:YAG laser
KTP laser
CO2 laser
Argon laser
During laser surgery, which eyewear pairing is most appropriate for personnel safety?
CO2: green tint; Nd:YAG: clear; KTP: red/amber/orange
CO2: clear; Nd:YAG: green tint; KTP: red/amber/orange
CO2: red/amber/orange; Nd:YAG: green tint; KTP: clear
CO2: clear; Nd:YAG: red/amber/orange; KTP: green tint
Which combination best reduces the risk of airway fire during laser airway surgery?
Use N2O for analgesia and inflate the cuff with air
Deliver FiO2 >60% and use a single-cuffed PVC tube
Deliver FiO2 <30%, avoid N2O, and fill the cuff with saline/methylene blue
Use jet ventilation with 100% oxygen and a standard cuffed tube
A specialized laser endotracheal tube is selected. Which feature is expected based on best practices?
Transparent PVC with single cuff filled with air
Matte-finish stainless steel, double-cuffed, cuff filled with saline
Aluminum tube with bright reflective finish and no cuff
Silicone tube with helium-filled cuff and plastic shield
During an intraoperative airway fire, which sequence best applies the protocol immediately after removing the burning endotracheal tube (ETT)?
Reintubate with regular ETT, then ventilate with 100% O2 by face mask
Extinguish the fire in the removed ETT in water, then ventilate with 100% O2 by face mask
Obtain chest X-ray, then consider bronchial lavage and steroids
Flush the airway with saline via bronchoscopy before ventilating
Refer to the fire triangle diagram showing 1. Fuel Source, 2. Ignition Source, 3. Oxidizer. Which numbered element represents what the anesthetist can primarily control within the operating room during endoscopic airway surgery?
1
2
3
None of the above
During laser airway surgery, which three are the main hazards that must be anticipated and mitigated? Select the best single answer that groups the correct trio.
Toxic fumes of viral particles, fire in the airway, electrical shock
Fire in the airway, eye injury, hyperthermia
Electrical shock, eye injury, hyperthermia
Toxic fumes of viral particles, eye injury, hyperthermia
Fire in the airway, electrical shock, hyperthermia
In planning an endoscopic airway procedure with laser use, which sequence reflects appropriate priorities for airway fire response planning before the first laser activation?
Ensure saline is available to douse flames, confirm laser-safe ETT or wet pledgets, agree on oxygen reduction plan and communication cues
Preoxygenate with 100% oxygen, increase FiO2 during laser use, place metal instruments near ETT
Rely on surgeon to manage all hazards, maintain normal FiO2, avoid team briefing
Secure backup electrical grounding pads and ignore eye protection when not near the beam
During microvascular free flap reconstruction, what intraoperative hematocrit target is described as desirable to optimize blood viscosity and oxygen carrying capacity?
20–24%
24–26%
27–30%
31–34%
35–38%
Which of the following is an indication for parotidectomy that specifically involves obstructive pathology within the gland?
Benign tumors
Parotid stones
Infection
Facial nerve palsy
A patient with generalized submental cellulitis from a dental abscess has swelling that pushes the tongue upward and backward. What is the most appropriate airway plan?
Delay airway intervention; start oral antibiotics only
Proceed with standard oral intubation under deep sedation
Prepare for fiberoptic intubation or tracheotomy with abscess drainage
Use nasal cannula oxygen and observe
During a parotidectomy, what intraoperative monitoring is specifically required to prevent iatrogenic injury?
Somatosensory evoked potentials
Facial nerve monitoring
Bispectral index (BIS) monitoring
Central venous pressure monitoring
Maxillofacial surgery may be indicated for all of the following EXCEPT:
Trauma involving LeFort fractures
Orthognathic procedures such as LeFort osteotomy
Radical cancer surgery
Endoscopic sinus surgery for chronic rhinitis
A trauma patient has midface crepitus, facial lengthening, bilateral epistaxis, and infraorbital paresthesia. Which LeFort fracture pattern is most likely?
LeFort I (nasomaxillary)
LeFort II (pyramidal)
LeFort III (craniofacial disjunction)
Isolated mandibular fracture
Which clinical sign best supports a diagnosis of LeFort III fracture compared to lower-grade patterns?
Buccal ecchymosis with maxilla mobile
CSF rhinorrhea with lateral orbital rim defect
Midface crepitus with facial lengthening
Epistaxis without orbital findings
In maxillofacial trauma, which clinical situation is a specific contraindication to nasotracheal intubation due to the risk that the endotracheal tube could enter the cranial vault and foreign material may be introduced intracranially?
LeFort I fracture
LeFort II or III fractures
Isolated mandibular fracture
Zygomatic arch fracture
A patient with complex midface fractures has severely limited mouth opening despite general anesthesia and muscle relaxation. Which airway plan best applies based on these challenges?
Proceed with routine direct laryngoscopy and oral ETT placement
Attempt positive-pressure mask ventilation only, avoiding advanced devices
Plan video or fiberoptic laryngoscopy and be prepared for a surgical airway
Delay surgery because LeFort fractures have no associated airway risk
