CUMMINGS HOUR EXAM (TRACHEOSTOMY)

Name: Score:

1. Early tracheostomy is associated with:

a. Increased duration of sedation
b. Increased long term mortality among ventilated patient
c. Reduced length of ICU stay
d. Decrease incidence of VAP compared with late tracheostomy
2. Late complication of tracheostomy:
a. Tracheal stenosis
b. Bleeding
c. Airway fire
d. Infection
3. In open tracheostomy, a 2-3 cm horizontal incision is marked at approximately the level of
a. Tracheal ring 1
b. Tracheal ring 2
c. Tracheal ring 3
d. Tracheal ring 4
4. Tracheostomy is recommended if mechanical ventilation is expected to exceed
a. 21 days
b. 7 days
c. 10 days
d. 14 days
5. Tracheal mucosa capillary perfusion pressure is approximately
a. 10-15mmHg
b. 30-35mmHg
c. 20-25mmHg
d. 25-30mmHg
6. Complications of tracheostomy can be classified as
a. Late (> 7 days)
b. Early (< 7 days)
c. Late (>10 days)
d. Early (<5 days)
7. Intraoperatively, bleeding is secondary to injury of the
a. Superior thyroid artery
b. Inferior thyroid vein
c. Anterior jugular vein
d. Common carotid artery
8. It is recommended that patients intubated if accidental decannulation occurs
a. Before 7 days
b. After 7 days
c. After 10 days
d. None of the above
9. Candidate for decannulation should be assessed for
a. Level of consciousness
b. Respiratory status
c. Ability to cough and swallow
d. All of the above
10. Initiation of airway fire requires:
a. Fuel source
b. Energy source
c. Oxidizing agent
d. All of the above
11. Absolute contraindication for percutaneous dilational tracheostomy except
a. Obesity
b. Midline neck masses
c. Cervical spine injury
d. Patient with coagulation abnormalities
12. Vertical incision begin at the inferior aspect of the cricoid and extend
a. 2-3cm superiorly
b. 3-4cm inferiorly
c. 3-4cm superiorly
d. 2-3cm inferiorly
13. Routine chest radiograph is indicated after tracheostomy
a. True
b. False
14. Risk factor for developing tracheinnominate fistula
a. Smoking
b. High placement of tracheostomy
c. Hyperflexion of head
d. Radiation
15. Unrecognized accidental decannulation can lead to
a. Atelectasis
b. Hemothorax
c. Pneumothorax
d. Aspiration
16. Tracheocutaneous fistula should be closed due to risk of
a. Pneumothorax
b. Aspiration pneumonia
c. Airway obstruction
d. Pneumomedisatinum
17. Percutaneous tracheostomy can be done in pediatric patients
a. True
b. False
18. This flap results in semipermanent tracheostoma
a. Bjorn flap
b. Jork flap
 c. Bjork flap
d. Jarl flap
19. Tracheostomy tube infection is less likely in PDT
a. True
b. False
20. Patients at risk for pressure ulcers, except:
a. Geriatric patients
b. Obese patients
c. Pediatric patients
d. Patient with sever kyphoscoliosis
21. It is the leading cause indication for tracheostomy
a. Airway obstruction
b. Surgical access
c. Prolonged mechanical ventilation
d. Pulmonary toilet
22. Tracheostomy is created between
a. 2nd and 3rd tracheal ring
b. 1st and 2nd tracheal ring
c. 4th and 5th tracheal ring
d. None of the above
23. Indication for tracheostomy
a. Airway obstruction
b. Extensive maxillofacial trauma
c. Depressed mental status
d. All of the above

24-25. There is a ___ risk of developing persistent tracheocutaneous fistula if a tracheostomy tube is
in place for more than ___

24. a. 20% 25. a. 4 months

b. 50% b. 7 months
c. 70% c. 4 weeks
d. 40% d. 10 weeks