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Apex Review > Respiratory pathophysiology 3 > Flashcards

Respiratory pathophysiology 3 Flashcards

1
Q

Asthma is defined by an

A

acute, reversible airway obstruction that is accompanied by chronic airway inflammation and bronchial hyperreactivity

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2
Q

____________ is the greatest risk factor for developing asthma

A

Atopy (the condition of being “hyper-allergic”)

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3
Q

Asthma has a __________ component

A

reversible!- bronchodilator therapy helps to improve

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4
Q

With asthma, ______________ are reduced but improve following bronchodilator therapy

A

FEV1
FEV1/FVC
FEF 25-75%

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5
Q

The most common ABG finding with asthma is

A

respiratory alkalosis with hypocarbia

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6
Q

With asthma, an elevated PaCO2 suggests

A

air trapping
respiratory muscle fatigue
impending respiratory failure

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7
Q

Key signs and symptoms of asthma include

A

wheezing
dyspnea
chest discomfort and/or tightness
productive or non-productive cough
prolonged expiratory phase
eosinophilia

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8
Q

What kind of extubation is preferred for asthmatics?

A

deep if not contraindicated

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9
Q

Ways to avoid triggering asthma include:

A

suppressing airway reflexes during airway instrumentation (consider an LMA or regional technique instead of tracheal intubation if possible)

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10
Q

What types of drugs should be avoided with asthmatics?

A

non-selective beta blockers (use beta 1 selective agents instead)
avoid histamine-releasing drugs (succinylcholine, atracurium, morphine, meperidine)

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11
Q

What should be done intraoperatively for asthmatics?

A

limit inspiratory time
prolong expiratory time
tolerate moderate permissive hypercapnia

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12
Q

Anesthetic agents that promote bronchodilation include

A

sevo
iso
ketamine
propofol
and lidocaine (IV or tracheal)

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13
Q

Stimuli that provoke s/sx of asthma include

A

allergens- environmental
drugs- aspirin, NSAIDs, beta antagonists, sulfites
infection-resp. virus
stress- vagal stimulation, cold air
exercise- usually following physical activity

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14
Q

With asthma, tachypnea and hyperventilation are the result of __________________ NOT ___________.

A

neural reflexes; NOT hypoxemia

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15
Q

A _________ retains airway humidity and may benefit patients with exercise-induced asthma.

A

heat-moisture exchanger

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16
Q

___________ can increase airway resistance and should be avoided in patients with aspirin-intolerant asthma.

A

Ketorolac

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17
Q

This obstetric drug can cause bronchoconstriction in asthmatic patients

A

Carboprost (hemabate)

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18
Q

____________ reduces the viscosity of airway secretions

A

Intravenous hydration

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19
Q

Although anticholinesterases could precipitate bronchospasm, co-administration of ______ negates the risk.

A

anticholinergics

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20
Q

_________ is the best choice beta blocker in asthmatics

A

esmolol because of its short 1/2 life and beta-1 selectivity

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21
Q

Presynaptic H2 receptor stimulation reduces ________

A

histamine release; can cause bronchospasm but risk is low

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22
Q

Which drug is LEAST likely to be effective in relieving symptoms of acute bronchospasm?
a. ketamine 1 mg/kg IV
b. epinephrine 1 mcg/kg IV
c. hydrocortisone 2 mg/kg IV
d. lidocaine 1.5 mg/kg IV

A

c. hydrocortisone 2 mg/kg- won’t help in acute phase b/c it takes several hours to take effect

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23
Q

Not all wheezing is asthma, so you must consider other etiologies in your differential diagnosis including

A

a kinked ETT
end-bronchial intubation
& pulmonary aspiration
pneumothorax
pulmonary edema
pulmonary embolus
light anesthesia leads to coughing and straining and reduced FRC

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24
Q

Intraoperative bronchospasm presents as

A

wheezing
decreased breath sounds
increased peak inspiratory pressure (decreased dynamic compliance)
increased alpha angle on the EtCO2 waveform

25
Q

Treatment for acute bronchospasm includes

A

100% FiO2
deepen anesthetic
short-acting inhaled beta 2 agonist
inhaled ipratropium
epinephrine 1 mcg/kg IV
hydrocortisone 2-4 mg/kg IV
aminophylline
helium-oxygen gas mixture

26
Q

Mechanical obstruction of ETT can be a result of

A

kinking
patient biting down
secretions
cuff overinflation

27
Q

_______________ is NOT used in the treatment of acute bronchospasm.

A

Montelukast

28
Q

Alpha-1 antitrypsin deficiency: (select 2)
a. increases the risk of bronchospasm
b. causes panlobular emphysema
c. can be treated with IgG
d. is the most common metabolic disease affecting the liver

A

b. causes panlobular emphysema
d. is the most common metabolic disease affecting the liver

29
Q

COPD is characterized by a reduction in

A

maximal expiratory flow and a slower forced emptying of the lungs

30
Q

Unlike asthma, air flow obstruction with COPD is

A

not fully reversible

31
Q

The name COPD is really an umbrella term for

A

chronic bronchitis and emphysema

32
Q

Chronic bronchitis is associated with

A

hypertrophied bronchial mucus glands and chronic inflammation

33
Q

Emphysema is associated with

A

enlargement and destruction of the airways distal to the terminal bronchioles

34
Q

Etiologies of COPD include

A

smoking
respiratory infection
exposure to environmental pollutants such as coal mining, gold mining, and textile industries
alpha 1 antitrypsin deficiency

35
Q

Inability to fully exhale leads to

A

gas trapping (increased residual volume)

36
Q

Chronically elevated PaCO2 causes

A

respiratory acidosis

37
Q

With COPD, the kidneys reabsorb bicarbonate which provides a

A

compensatory metabolic alkalosis

38
Q

Administering supplemental oxygen to the patient with severe COPD does

A

not inhibit the “hypoxic drive”

39
Q

Administering supplemental oxygen to the patient with severe COPD can cause

A

oxygen-induced hypercapnia due to inhibition of hypoxic pulmonary vasoconstriction
The Haldane effect

40
Q

To minimize the risk of oxygen-induced hypercapnia in the patient with severe COPD, you should titrate the FiO2 to maintain the SaO2 between

A

88-92%

41
Q

Common findings in patients with COPD include

A

flattened diaphragm
increased AP diameter
pulmonary bullae
increased work of breathing

42
Q

______________ removes over distended tissue and allows normal lung tissue to function in a more regular way for patients with COPD

A

Lung reduction surgery

43
Q

Chronic bronchitis is defined by the presence of

A

cough and sputum production for more than three months for two consecutive years

44
Q

The common cause of chronic bronchitis is

A

cigarette smoking

45
Q

What happens to the heart in chronic bronchitis?

A

left heart function is normal (normal PAOP)
a weak right heart creates a back pressure on the liver–> liver congestion and ascites

46
Q

_________________ is more efficacious than any drug in terms of improving pulmonary hypertension and preventing erythrocytosis in chronic bronchitis.

A

Oxygen therapy

47
Q

With chronic bronchitis, RBCs are

A

overproduced to compensate for V/Q mismatch and hypoxemia
leads to increased blood viscosity and myocardial work

48
Q

With chronic bronchitis, chronic hypoxemia and hypercarbia increase PVR leading to

A

pulmonary hypertension–> RV strain–> cor pulmonale

49
Q

Emphysema is associated with

A

enlargement and destruction of the airways distal to the terminal bronchioles

50
Q

Emphysema results in

A

increased dead space & destruction of the pulmonary capillary bed leading to pHTN

51
Q

_______ can cause emphysema

A

Alpha-1 antitrypsin deficeincy

52
Q

The patient with emphysema generally has a normal or slightly reduced

A

PaO2
PaCO2 is usually normal or decreased (as a result of hyperventilation)

53
Q

Late in emphysema, hypoxemia and hypercarbia further

A

increase PVR leading to RHF

54
Q

Alpha 1 antitrypsin is an enzyme produced by

A

the liver

55
Q

Alpha-1 antitrypsin deficiency is a disease where

A

an abnormal variant of the enzyme is produced

56
Q

Alpha 1 antitryspin deficiency allows a relative overactivity of

A

alveolar elastase activity resulting in destruction of pulmonary connective tissue and the development of panlobular emphysema

57
Q

What spirometry values are increased in COPD?

A

RV, FRC, TLC

58
Q

What spirometry values are decreased in COPD?

A

FEV1, FEV1/FVC ratio, FEF 25-75%

59
Q

An FEV1/FVC ratio of <70% after bronchodilator therapy is diagnostic of

A

COPD

Apex Review (224 decks)

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