Deck 10: Otorhinolaryngologic Surgery

Question 1

The nasal turbinates increase the turbulence of the airflow through the nose to humidify the air. The turbinates also serve another function to the accessory sinuses by:

A)filtering inspired air and preventing sinusitis.
B)acting as drainage passageways.
C)giving resonance to the voice.
D)trapping particle matter before it reaches the nasopharynx.

Answer 1

B
The turbinates act as drainage passages of the accessory sinuses and also increase the turbulence of airflow to humidify the air that is nasally inspired. This area is commonly referred to as the sphenoethmoidal recess and contains the bony shelves known as the superior, middle, and inferior meatus or turbinates .

Question 2

Select the structure of the trachea that is a landmark during bronchoscopy.

A)Cartilaginous ring
B)Cricoid cartilage
C)Carina
D)Right main bronchus

Answer 2

C
The posterior surface of the trachea is flattened rather than round because the cartilaginous rings are incomplete. The carina is a ridge on the inside of the bifurcation of the trachea. It is a landmark during bronchoscopy and separates the upper end of the right main branches from the upper end of the left main branches of the bronchi.

Question 3

The surgical microscope is often used to provide illumination and magnification for complex procedures to the ear, laryngeal surgery, or reconstructive free flap procedures following neck surgery. A common eyepiece magnification for an otologic microscope is 12.5, and the usual objective (lens) is ______- mm focal length (f). A _______- mm lens is used for laryngeal surgery.

A)250 or 300; 400
B)400; 150
C)150; 400
D)400; 250 or 300

Answer 3

A
Several kinds of surgical microscopes with different attachments are available for otologic and laryngologic surgery. A common eyepiece magnification for an otologic microscope is 12.5, and the usual objective (lens) is 250- or 300-mm focal length (f). A 400-mm lens is used for laryngeal surgery. The total magnification is determined by multiplying the magnification of the eyepiece times that of the microscope body times that of the objective. The type of head and objective selected is based on the surgeon's preference. Microscopes equipped with a variable distance feature allow the surgeon to adjust the focal length from 200 to 400 mm without changing the lens objective.

Question 4

Of the three salivary glands, which one is the largest?

A)Sublingual
B)Submandibular
C)Zygomatic
D)Parotid

Question 5

Both ears provide stereophonic hearing that gives us very specific hearing capabilities. Binaural hearing makes it possible for:

A)determination of the source location of sounds.
B)enhanced voice recognition.
C)amplification and resolution of sound properties.
D)recognition of more than one sound at a time.

Question 6

The external ear canal lining is protected and lubricated with cerumen (earwax), which traps foreign material and:

A)liquefies foreign matter in the ear canal.
B)lubricates the external ear.
C)maintains the acidic pH in the ear canal.
D)reduces bacterial levels in the outer ear.

Question 7

The nasal septum is lined with blood vessels and mucus-secreting cells. The proper name of this lining is the:

A)Mucoperichondrium
B)Septochondrium
C)Nasoseptal mucosa
D)Cartilaginous vascular bed

Question 8

What mouth structure is considered the boundary between the buccal cavity and the lingual cavity?

A)Hard palate
B)Soft palate
C)Teeth
D)Floor of the mouth

Question 9

The salivary glands produce saliva, which serves to moisten the mouth and initiate:

A)antibacterial activity in the mouth.
B)carbohydrate digestion.
C)enzymatic activity on all ingested food.
D)alimentary (GI) tract peristalsis.

Question 10

The cricoid cartilage is a complete cartilaginous ring that resembles a signet ring; it rests beneath the thyroid cartilage and supports the airway. What membrane, attached to the midline of the upper thyroid cartilage, protects the larynx during swallowing?

A)False vocal cords
B)True vocal cords
C)Arytenoids
D)Epiglottis

Question 11

Several types of diagnostic imaging studies visualize structures by producing serial sections through different anatomic planes, highlighting specific structures or tissue densities. Examples of these imaging diagnostics would be:

A)complementary CT scan with MRI.
B)MRI scan.
C)CT scan.
D)All of the options

Question 12

What is the purpose of using an intravenous injection of a radiopaque contrast dye during select imaging diagnostic studies?

A)There is enhanced uptake of radiation in areas of suspicion.
B)It provides visual enhancement of anatomic structures.
C)It minimizes ionizing radiation scatter to noninvolved anatomic structures.
D)Contrast dye leaves a locator marker for impending surgery.

Question 13

The nose is divided into the prominent external portion and the internal portion known as the nasal cavity. The primary purpose of the nose is to:

A)facilitate the sense of smell.
B)warm inspired air.
C)moisturize inspired air.
D)prepare inspired air for the lungs.

Question 14

Audible facial nerve monitors (nerve integrity monitor systems) are used intraoperatively during procedures in which the facial nerve is at risk for injury. The purpose of this monitoring technique is to assist in the early identification of the nerve, to increase the possibility of its preservation by minimizing trauma, and to assess its integrity after dissection. Communication with the anesthesia provider is essential because:

A)the electrodes are often in proximity to the anesthetic airway.
B)manipulation of the anesthetic airway during the procedure can misplace the electrodes.
C)muscle relaxants, paralyzing agents, and some local anesthetics must be avoided.
D)the anesthesia provider is responsible for the facial nerve monitoring.

Question 15

A chain of three small articulated bones extends across the middle ear cavity and conducts vibrations from the tympanic membrane across the middle ear into the oval window and the fluid-filled inner ear. What are the names of those three small articulating bones?

A)Ossicles, incus, and crura
B)Stapes, capitulum, and stirrup
C)Malleus, incus, and stapes
D)Anvil, head, and hammer

Question 16

Which of the diagnostic modalities listed below does not employ the use of ionizing radiation?

A)Audiogram
B)Magnetic resonance imaging (MRI)
C)Computed tomography (CT)
D)Both audiogram and magnetic resonance imaging (MRI)

Question 17

The external ear, which includes the auricle (or pinna) and external auditory canal, is composed of cartilage covered with skin. The primary function of the auricle is to:

A)gather and direct sound waves toward the inner ear.
B)concentrate and conduct incoming sound waves into the external auditory canal.
C)collect and amplify incoming sound waves by facilitating tympanic membrane vibration.
D)facilitate air conduction of sound waves.

Question 18

The nasal cavity is associated with the ear by way of the ____________, and communicates with the conjunctiva through the __________________. Select the options that are appropriate to complete the sentence.

A)torus tubarius; canaliculi
B)eustachian tube; nasolacrimal duct
C)nasopharynx; medial caruncle
D)middle ear; lacrimal sac

Question 19

The supraglottis, glottis, and the subglottis represent three portions of which structure of the throat?

A)Epiglottis
B)Tongue
C)Larynx
D)Pharynx

Question 20

The palatine and lingual tonsils are situated in the oropharynx, while the adenoids are located in the nasopharynx. Both adenoids and tonsils consist of:

A)lymphoid tissue.
B)glandular tissue.
C)vascular tissue.
D)mucosal tissue.

Question 21

When laryngoscopy, bronchoscopy, and esophagoscopy are performed in a single session on a patient, the procedure is termed triple endoscopy or panendoscopy. The purpose of triple endoscopy is usually diagnostic. A critical role of the surgical technologist in the scrub role during this complex diagnostic procedure is that of:

A)documenting the serial numbers of the scopes in the perioperative record.
B)identifying, containing, and labeling all specimens accurately.
C)carefully handling and reprocessing the endoscopes.
D)assisting the anesthesia provider with maintaining the airway.

Question 22

During otolaryngologic procedures using local anesthetic, the perioperative team plans the environment of care as a quiet, warm, and functional domain of healing and comfort. An important consideration with most otolaryngologic patients identifies their specific _________ needs.

A)communication
B)anxiety
C)airway
D)pain

Question 23

Acoustic neuromas arise from the Schwann cells of the vestibular portion of the eighth cranial nerve and are benign tumors. What is the postauricular incisional approach that offers the best chance of saving the integrity of the facial nerve?

A)Transaural
B)Supraaural
C)Translabyrinthine
D)Intravestibular

Question 24

Patients scheduled for otologic surgery may have undergone evaluation of their hearing through audiograms to determine whether they have which of these diagnoses? Select all answers that apply.

A)Normal hearing
B)Sensorineural hearing loss
C)Conductive hearing loss
D)Mixed loss of hearing from combination of conductive and sensorineural
E) None of the above

Question 25

A stapedotomy is removal of the stapes superstructure and creation of a fenestra (opening) in the fixed stapes footplate for treatment of abnormal bone growth around the footplate that results in its immobility. A prosthesis is placed to restore ossicular continuity and alleviate conductive hearing loss. The patient scheduled for a stapedotomy will probably have a surgical diagnosis of:

A)otosclerosis.
B)ossicular immobility.
C)indeterminate hearing loss.
D)All of the options apply.

Question 26

During endoscopic sinus surgery, patient eye protection includes:

A)taping the eyelids closed.
B)placing moist gauze over the eyelids.
C)instilling eye lubricant into both eyes.
D)All of the options apply

Question 27

The Caldwell-Luc procedure is a radical antrostomy used to establish a large opening into the wall of the inferior meatus leading to the sinuses. Where is this large incisional approach made?

A)Proximal to the maxillary artery
B)Antrum wall on the affected sinus side
C)Canine fossa of the upper jaw
D)Intranasally on the affected sinus side

Question 28

Myringotomy is often accompanied by the aspiration of fluid under pressure in the tympanum, and the subsequent placement of small, hollow, pressure equalization tubes. It is indicated for acute otitis media (AOM) in the presence of an exudate that has not responded to antibiotic therapy. If left untreated, what is the main concern for a child with chronic otitis media?

A)Impaired language development
B)Encephalitis
C)Hearing loss
D)Impaired language development and hearing loss

Question 29

When microlaryngoscopy is performed to remove polyps or nodules from the vocal cords, what important postoperative instruction must be provided to the patient during preparation for discharge?

A)Complete voice rest is important.
B)Coughing and deep-breathing exercises should be performed.
C)Clearing the throat to remove secretions is advised.
D)The patient should use a humidifier.

Question 30

Oral malignancies can be linked to specific carcinogens, the most important one being tobacco. Benign or malignant lesions of the tongue, floor of the mouth, alveolar ridge, buccal mucosa, or tonsillar area are excised depending on the extensiveness of disease, involvement of surrounding vessels and nerves, and candidacy for surgery. Benign or small malignant tumors of the oral cavity may be excised without a neck dissection. What indicator would prompt the surgeon to perform a neck dissection for benign or small malignant tumors?

A)Evidence of disease in the upper lymphatic chain
B)Suspicious metastatic disease
C)Presence of diagnosed malignancy
D)All of the options would be indications for neck dissection

Question 31

Benign or small malignant tumors of the oral cavity may be excised without a neck dissection, though in the presence of diagnosed or highly suspicious metastatic disease, a selective neck dissection may be performed in an effort to control a cancerous growth in the upper jugular lymphatic chain of the neck. Typically, endotracheal anesthesia is used and a pharyngeal pack of moist gauze may be inserted in the mouth. The perioperative team must be prepared for which additional procedure when head and neck surgery is performed?

A)Tracheostomy
B)Microscopic free flap graft
C)Laryngoscopy
D)Difficult airway protocol

Question 32

Laryngoscopy is direct visual examination of the interior of the larynx by means of a rigid, lighted speculum known as a laryngoscope to obtain a specimen of tissue or secretions for pathologic examination. What action should the surgical technologist take in preparing for the conclusion of the procedure?

A)Maintain instrument setup until the patient leaves the OR.
B)Determine fire risk score.
C)Place O2 tank, nasal cannula, and bag/valve/mask on the transport vehicle.
D)Assist anesthesia provider with anesthesia emergence and transfer to the PACU.

Question 33

Functional endoscopic sinus surgery (FESS) provides a more physiologic type of drainage by reducing trauma to normal tissues. FESS involves the endoscopic resection of inflammatory and anatomic defects of the sinuses. Select all of the appropriate indications listed below for FESS.

A)Inhibited mucociliary clearance
B)Impaired nasal ventilation
C)Mucocele
D)Sinus infections
E) None of the above

Question 34

Tympanoplasty is the surgical repair of the tympanic membrane and the tympanum and the reconstruction of the ossicular chain. Conductive hearing loss is caused by an obstruction in the external canal or middle ear, which impedes the passage of sound waves to the inner ear. A common cause of conductive hearing loss would be:

A)acute otitis media.
B)fluid invasion of the ear canal.
C)perforation of the tympanic membrane.
D)a healed myringotomy.

Question 35

Lasers assist in vaporization of scar tissue, granulomas, and cholesteatomas without damaging surrounding tissue and may be used for select otolaryngologic procedures. Lasers can be secured to the operating microscope and laser energy delivered to the tissue by means of a:

A)fiberoptic probe.
B)beam separator.
C)micromanipulator.
D)flexible micro laser fiber.

Question 36

A power drill and assorted rotating burrs are essential for middle ear surgery and some sinus procedures. A selection of burrs including assorted sizes of round cutting burrs and diamond polishing burrs should be available. During drill and power saw use, the scrub person keeps irrigation solution on the sterile field to:

A)keep the drill bit or burr cool and prevent breaking.
B)prevent clogging of the burr and contamination of the area with bone dust.
C)prevent aerosolized bone dust particles, because they are an occupational hazard.
D)avoid using a wire brush.

Question 37

A nasal polypectomy is the removal of polyps from the nasal cavity. Nasal polyps are benign, grapelike clusters of mucous membrane and connective tissue. When the polyps become large, they obstruct the free passage of air, make breathing difficult, and cause a change in speech quality. Nasal polypectomies are typically performed endoscopically with the use of microdebriders, which remove the polyps by their mechanism of _______________ the polyp and suctioning the tissue.

A)ultrasonic cavitating
B)morcellating
C)radiofrequency ablating
D)laser vaporizing

Question 38

Sally Andres and her orientee have returned from an airway fire simulation exercise with the otorhinolaryngologic surgeon, fellow, and anesthesia provider. They were amazed at the statistics for OR fires and the threat of serious injury to the patient and team. Patients undergoing otorhinolaryngologic procedures are at greater risk for fire injury because of the proximity of the surgical field to high concentrations of oxygen. The team discussed a plan to change their practices. An example of a risk reduction strategy that involves collaboration of the entire surgical team during otorhinolaryngologic surgery would be:

A)placing ESU active electrodes in a secure holster.
B)maintaining the laser on standby until needed.
C)identifying the fire risk score during the preincision time-out.
D)conducting regularly scheduled team simulations that rehearse an airway fire protocol.

Question 39

During the preoperative assessment for a patient scheduled for nasal surgery using a local anesthetic that includes epinephrine, what important consideration, relevant to epinephrine use, should be explored?

A)Coagulopathy
B)Renal clearance
C)Cardiac status
D)Anxiety