May 3rd Conference Review Questions

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Fellows Meeting, Tracheostomies with Dr. Preciado, Head CT/MRI with Dr. Vezina

1.       You are called to the bedside of a 9 month old M trach and g-tube dependent patient who presents with acute shortness of breath.  On exam, the baby is in obvious distress with cyanosis, deep retractions and minimal aeration bilaterally despite bagging; O2 sats are not picking up, HR is 180.  Mom tells you that he is vent-dependent and that he was just recently discharged from CNMC after placement of the trach.  She has brought her extra replacement trach tube with her.  The baby continues to have poor ventilation despite suctioning.  Your next step is to attempt to:

a)       Continue bagging through the trach and call ENT and Anesthesia to the bedside STAT

b)       Attempt oral endotracheal intubation

c)        Remove the tracheostomy tube and replace with another tracheostomy tube

d)       Remove the tracheostomy tube and replace with an endotracheal tube

2.       All of the following are true statements regarding pediatric tracheostomy tubes EXCEPT:

a)      Patients who have tracheostomies secondary to ventilation issues are more likely to have uncuffed than cuffed tracheostomy tubes

b)      If left without a tracheostomy tube, most trach stomas will close within one day

c)       The size of tracheostomy tube (2.5, 3.0, etc) reflects the inner diameter of the tube in mm

d)      The only difference between peds and neo tracheostomy tubes is in the length of the tube

3.       You are reviewing the head CT of an 8 year old unrestrained passenger in a motor vehicle collision who was intubated in the trauma bay for a GCS of 6.  Which of the following best describes the finding indicated by the white arrow?

a)      Epidural hematoma because of its classic crescentic shape

b)      Subdural hematoma because it crosses suture margins

c)       Epidural hematoma because it is not associated with a calvarial fracture

d)      Subdural hematoma because of its classic biconvex appearance

4.       On the following diagram, which number best corresponds to   uncal herniation?

a)      1

b)      2

c)       3

d)      5

5.       A 3 year old M with multiple medical problems, including VP shunt, is brought in for increased somnolence and emesis.  VS are stable upon arrival, a PIV is placed and the patient is sent for CT to rule out shunt malfunction.   Of the following radiographic findings, which would be most alarming?

a)      Enlarged ventricles bilaterally compared to the prior CT

b)      Unilateral L ventricle enlargement compared to the prior CT

c)       Stable ventricular size but a disconnect in the proximal shunt tubing

d)      Stable ventricular size but loss of the quadrigeminal cistern at the level of the midbrain

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