1.Tracheostomy will

a) Increase dead air space
b) Increase respiratory resistance
c) Decrease respiratory work
d) Cause obstruction in respiration

2.Which of the following conditions may necessitate emergency procure tracheostomy to prevent suffocation

a) Cellulitis
b) Ludwig’s angina
c) Cavernous sinus thrombosis
d) Maxillary sinusitis

3.If an emergency tracheostomy is to be performed the incision should be

a) Vertical
b) Horizontal
c) Oblique
d) Paramedian

4.Early post operative complications of tracheostomy are all except

a) Apnea
b) Haemorrhage
c) Pneumomediastinum
d) Tracheal stenosis

5.Tracheostomy is indicated in

a) Head injury with unconsciousness
b) Foreign body obstruction
c) Major surgery involving the oral cavity
d) All of the above

6.Which of the following is not a complication of tracheostomy

a) Surgical emphysema
b) Pneumothorax
c) Carotid artery injury
d) Subglottic stenosis

7.In tracheostomy , the entry into the trachea is through the

a) cricoid cartilage
b) first trachea ring
c) second and third tracheal ring
d) 4th and 5th tracheal ring

8.A chronic smoker with history of hoarseness was found on examination to have keratosis of the larynx. all of the following are possible treatment odalities except

a) Laser vaporizer
b) Stop smoking
c) Stripping of the vocal cord
d) Partial laryngectomy

9.Standard airway for Ludwig angina is

a) Tracheotomy
b) Cricothyrotomy
c) Nasal Intubation
d) Oral intubation

10.Laryngeal edoema a life threatening situation is seen in association with

a) Cavernous sinus thrombosis
b) Infection of pharyngeal tonsils
c) Ludwig’s angina
d) Cellulitis

Answers with explanation

1. C
all forms of tracheostomy an cricothyroidotomy have the following advantages reduces anatomical Dead Space by 50 percentage, work of breathing is reduced, alveolar ventilation is increased, the level of sedation needed for patient comfort is decreased.

2.B
Ludwig angina is a severe form of Cellulitis involving the submandibular, sublingual and submental spaces.It is clinically manifested as a board like swelling of the floor of the mouth and consequent elevation of the tongue giving rise to dysphagia initially and subsequent airway obstruction. Treatment consist of broad spectrum antibiotics and incision and drainage. Tracheotomy is necessary in cases of odema the glottis.

3.A.
A vertical incision is preferred as it is inconspicious and heals well.

4.D
Tracheostomy complications
Intraoperative complications

• Haemorrhage
• Injury to para tracheal structures
• Carotid artery,recurrent laryngeal nerve, oesophagus
• damage to trachea.

Early postoperative complications

Apnoe caused by fall in PCo2,haemorrhage, subcutaneous emphysema, pneumo mediastinum, pneumothorax, Infection,Swallowing dysfunction

Late postoperative complications

• Difficult decanulation
• Tracheocutaneous fistula
• Tracheooesophageal fistula
• Tracheoinnominate arterial fistula with severe haemorrhage.
• Tracheal stenosis.

5.D
Indications for tracheostomy

• Acute upper airway obstruction.
• Major surgery involving the mouth, pharynx or larynx.
• Patients requiring artificial respiration
• In unconscious patients – head injuries, coma, tetanus or bulbar poliomyelitis.

6. D
Complications of tracheostomy are
Heamorage,Damage to carotid artery, trachea, recurrent laryngeal nerve, subcutaneous emphysema, pneumothorax ,infection and tracheal stenosis.

7. C
In tracheostomy, the entry into the trachea is through 2nd- 4rth tracheal rings. Entry through first ring results in Tracheal stenosis and entry through 5th to 7th rings is very difficult.
Entry through cricothyroid Membrane is called cricothyroidotomy which is a life saving procedure when endotracheal intubation is not possible.

8. D.

9.B
In ludwig’s angina, cricothyrotomy is always preferred over option A.Tracheotomy, is avoided because of the following reasons
Identification of landmarks is difficult due to associated massive edoema and tissue distortion,
Sometimes, tracheostomy may lead to spread of infection to deeper issues.
May result in tracheal stenosis in 25%-50% cases.
Chances of getting pneumonia will always be there

10. C