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1 Resp Patho Flashcards

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1
Q

Bronchodilation: which receptor/g protein/2nd messenger/release. Ends when

A

B2, Gs, Adenylate cyclase, cAMP (2nd), reduces Ca release from SR, bronchodilators. End w pd3 converting cAMP to AMP

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2
Q

NO: which nerves it acts on, stim what

A

Non cholinergic PNS nerves to release VIP and inc NO produc, stim cGMP to dilate

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3
Q

Bronchoconstriction: nerve, release what onto what, G protein, 2nd mess, turned off when

A

CN X, Ach onto M3, Gq to phos C, IP3 (2ND), ca release from SR. Turned off when IP3 to IP2

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4
Q

C fiber mediators that bronchoconstriction

A

Sub p, neurokinin A, calcitonin gene related peptide

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5
Q

Steroids interfere where

A

Block mast cells from stim arachidonic acid leading to leukotrienes

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6
Q

Cromolyn affects what

A

Release of cytokines, leukotrienes, histamine

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7
Q

Methylxanthines affect what

A

PDE to stim cAMP, dec ca release and cause relaxation

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8
Q

Beta 2 ag effect on K

A

Hypokalemia

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9
Q

How anticholinergics work to dilate

A

Antagonize M3, dec IP3 and ca release

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10
Q

Methylxanthines: drug example, side effects when >20 mcg/ml

A

Theophylline. NVD, HA, cant sleep

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11
Q

Theophylline SE when >30 mcg/ml

A

Sz, tachydysrhythmias, CHF

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12
Q

Fev1: Effort ____, declines w ___, nml value

A

Dependent, age,>80% of predicted

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13
Q

FVC: effort ___, M/F nml

A

Dependent. 5L, 3.7L

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14
Q

FEV1/FVC ratio nml

A

80%

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15
Q

FEF 25-75: effort ___, tests what, nml

A

Less effort dependent, middle airway flow, 75-100% predicted

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16
Q

MVV: test of ___,nml

A

Endurance. M: 160L, F: 100

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17
Q

Dlco: test of what, nml

A

Gas exchange, 17-25 ml/min/mmhg

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18
Q

Procedure high to low risk for pulm complic

A

Aortic > thoracic> upper abd = neuro = peripheral vascular > emergency

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19
Q

Which lab test does and doesnt show risk pulm postop complic

A

Does: albumin <3.5. Doesnt: abg and pft

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20
Q

Smoking cessation: when CO and p50 return to normal

A

T1/2 4-6 hr CO. P50 returns 12 hours

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21
Q

Smoking cessation: when pulm func returns and when hepatic enzyme induc subsides

A

6 weeks for both

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22
Q

How to do ARMs

A

PIP to 40 for 8 seconds

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23
Q

Obstructive disease: which tests are normal, low, or hi nml

A

Nml/hi nml: RV, FRC, TLC. Low: ratio and fef 25-75. Low nml: FVC and fev1.

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24
Q

Restrictive disease: tests that are low vs nml

A

Low: FVC, fev1, RV, FRC, tlc. Nml: ratio, 25-75

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25
How to differentiate on spirometry: obstructive, restrictive, fixed
Obstruc: concave exp limb. Fixed: flat insp and exp limbs. Restrictive: smaller and shifted right
26
Flow volume loop: direction of breathing, exp vs insp on chart, vol on chart
Clockwise, exp on top insp bottom. Vol increases right to left
27
Extrathoracic vs intrathoracic obstruction on flow vol loop
Extra: insp limb flat, intra: exp limb flat
28
Asthma: greatest risk factor, tests that are reduced
Autopsy. FEV1, fev1/FVC ratio, 25-75 (all imp w dilator tx)
29
Asthma: what ekg may show, flow vol loop changes not caused by wheeze w asthma
R axis dev. Insp or exp limb totally flat
30
Asthma vent settings
Limit insp time, prolong exp time, mod permissive hypercapnia
31
Why h2 antag bad in asthma
Unopposed h1 stim leading to bronchospasm
32
Bronchospasm tx order
02, deepend anesthesia, B2 ag (albuterol), ipratropium inhaled, epi 1 mcg/kg iv, hydrocortisone 2-4 mg/kg to prevent complic later, aminophylline (not Theo), heliox
33
Why restoring paco2 to nml in COPD bad
HCO3 in blood hasn’t gone anywhere, risk severe alkalosis and apnea
34
COPD: rely on what for resp drive. Diagnosis when
Pa02. Ratio <70% after bronchodilator therapy
35
COPD: avoid block above what, what may risk rupture of blebs/ptx
T6, nitrous
36
COPD: tv, other vent consid
6-8 ml/kg IBW, inc exp time
37
Causes of auto peep
Large tv, inc rr, bronchoconstriction, inc a/w resistance
38
Cardiac fx auto peep
Dec venous return, hypotension, overstim cvp and paop
39
Restrictive disease: diagnosis, causes of chronic intrinsic
Ratio <70%. Sarcoidosis or amio
40
Restrictive disease: TV, RR, PIP
6 ml/kg, 14-18, <30, 1:1
41
Mendelsons syndrome diagnosis
Ph <2.5, vol >25 ml
42
First action in aspiration, other actions
Tilt head down or to side, upper then lower a/w suction, secure airway, peep, dilators, iv lido
43
Hallmark signs tension ptx
Hypoxemia, inc a/w p, tachycardia, hypotension, inc CVP
44
Where chest tube goes ptx
2nd IC mid clavicle or 4-5th IC space ant axillary line
45
Chylothorax risk w CVL which side
Left
46
Hemothorax: when thoracotomy indicated
>1l initial drainage, >200ml/hr, white on cxr and air leak
47
Hemothorax: when vats ok
<150 ml/hr
48
Flair chest chest movement
Ribs move in with insp and out with exp
49
High to low risk positioning for VAE
Sitting, supine, prone, lateral
50
S/s highest to lowest sensitivity VAE
TEE, Doppler (no physio changes), PAP/ETCO2, CO/CVP (modest changes), BP/EKG (collapse)
51
Tx vae order
02, flood field, d/c insufflation, L lateral, aspirate air, hemodynamic support
52
Pulm htn: fixed what that’s dependent on what
CO, preload
53
PVR calculation, nml
(Mean PAP- PAOP) X 80 / co. 150-250
54
Causes inc PVR: ___ temp, drugs, ___ valve disease
Low, NO/Ketamine/des, mitral
55
Drugs that decrease PVR
Nitric, ntg, pde inhib, prostaglandins, Ccb, ace inhib
56
If elev RA pressure w/inc PVR: do what to prevent r to l shunt or reverse it
Reverse causes of inc pulm resistance
57
Drug of choice when too much preload w inc PVR
NTG
58
Carboxyhgb: shift where in curve, dx, pt appearance, pulse ox
Shift left, co oximetry. Pulse ox falsely elevated. Cherry red not cyanotic
59
Tx carboxyhgb
100% 02 until cohgb <5% for 6 hours. Hyperbaric if >25% or symptomatic
60
Risk greatest to least CO with soda lime. Which does compound a
Des, iso, sevo. Sevo
61
Drugs you can give down ett
Narcan atropine vaso epi lido
62
VC and insp force when need ett
<15, <25
63
Pa02 and A-a when need ett at 21%
<55 >55
64
Pa02 and Aa at 100% 02 when need ett
<200 and >450
65
RR and CO2 when need ett
>40 or <6, >60
66
Best predictors of postop pulm complic from pulm sx
FEV1 <40%, dlco <40%, VO2 max <15 ml/kg/min
67
DLT size and insertion depth men v women
Men: 39-41, 29 cm. Women: 37-39, 27 cm
68
DLT sizes in peds, when you cant do one
8-9 26 fr, 10+ 28-32 fr. If <8 years old
69
Where scope inserted mediastinoscopy, ptx risk which side
Ant to trachea post to innominate. Right side
70
Mediastinoscopy: absolute v relative contraindications
Absolute: previous one. Relative: trach dev, thoracic aortic aneurysm, SVC obstruction

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