Missed apex flashcards

Question 1

Define alveolar deadspace.

Answer 1

Ventilation without perfusion

Question 2

List an example of anatomic dead space.

Answer 2

Nose/mouth–>terminal bronchioles

Question 3

Ventilation is greatest at the _______ due to __________

Answer 3

base due to high alveolar compliance

Question 4

Recite the alveolar gas equation.

Answer 4

Alveolar oxygen= FiO2 x (Pb-PH2O) - PaCO2/RQ
Rq = 0.8
PH2O= 47

Question 5

The A-a gradient helps us diagnose the cause of

Answer 5

hypoxemia by quantifying the amount of venous admixture

Question 6

A normal A-a gradient is

Answer 6

15 mmHg

Question 7

The A-a gradient is increased by

Answer 7

high FiO2, aging, vasodilators, R to L shunt, and diffusion limitation

Question 8

An awake intubation should be considered if an anticipated difficult airway is coupled with what 4 risks

Answer 8

suspected difficult mask ventilation
suspected difficult LMA placement
increased risk of aspiration
decreased apneic time

Question 9

What is the maximum recommended peak inspiratory pressures for an LMA unique vs. LMA proseal vs. LMA supreme?

Answer 9

Unique: <20 cmH2O
Proseal & supreme: <30 cmH2O

Question 10

What is the maximum ETT that will fit through a 2 & 2.5 LMA

Answer 10

LMA 2: 4.5
LMA 3: 5

Question 11

When is a nasopharyngeal airway contraindicated?

Answer 11

Cribiform plate injury
coagulopathy
transphenoidal hypophysosectomy
nasal fracture
previous Caldwell-Luc procedure

Question 12

Treatment for angioedema caused by ACE-I or C1 esterase deficiency?

Answer 12

FFP
icatibant
ecallintide
C1 esterase concentrate

Question 13

5 risk factors for difficult invasive airway placement include

Answer 13

laryngeal trauma
altered neck anatomy (tumor, goiter)
obesity (can’t ID cricothyroid membrane)
Short, thick neck (can’t ID cricothyroid membrane)
Limited access to cricothyroid membrane (Halo, neck flexion deformity)

Question 14

How many centimeters is a normal inter-incisor gap?

Answer 14

4 cm
(2-3 fingerbreaths)

Question 15

What is the treatment for carbon monoxide poisoning?

Answer 15

100% FiO2 until CoHgb is <5% for 6 HOURS
hyperbaric O2 if CoHgb is >25% or pt. is symptomatic

Question 16

What measures carbon monoxide and what is a s/sx?

Answer 16

Co-oximeter
cherry red appearance

Question 17

If soda lime is desiccated, then volatile anesthetics can produce CO in the following order:

Answer 17

des>iso»» sevo

Question 18

Pulmonary hypertension is defined as

Answer 18

a PAP >25 mmHg

Question 19

What drugs increase pulmonary vascular resistance?

Answer 19

nitrous oxide
desflurane
ketamine

Question 20

List the 5 drug classes that can be used for prevention of aspiration pneumonitis.

Answer 20

H2 blockers: famotidine, cimetidine
antiemetics: ondansetron
antacid: sodium bicitrate
GI stimulants: metoclopramide
PPI: protonix, omeprazole

Question 21

What are four examples of extrinsic lung disease that affect the chest wall/mediastinum?

Answer 21

kyphoscoliosis
flail chest
mediastinal tumor
neuromuscular disorders

Question 22

What is alpha 1 antitrypsin deficiency?

Answer 22

alveolar elastase is a natural enzyme that breaks down pulmonary connective tissue
this enzyme is kept in check by alpha 1 antitrypsin
will see pan lobar emphysema

Question 23

What is the definitive treatment for alpha 1 antitrypsin deficiency?

Answer 23

liver transplant

Question 24

An extrathoracic tumor is abnormal during

Answer 24

inspiration and normal during expiration

Question 25

An intrathoracic tumor is abnormal during

Answer 25

expiration and normal during inspiration

Question 26

Why can’t spirometry measure FRC?

Answer 26

because it includes RV

Question 27

What are the five causes of hypoxemia?

Answer 27

low FiO2
hypoventilation
diffusion limitation
shunt
V/Q mismatch

Question 28

What causes of hypoxemia have a normal A-a gradient?

Answer 28

low FiO2
hypoventilation

Question 29

What causes of hypoxemia can be fixed with supplemental O2?

Answer 29

low FiO2
hypoventilation
diffusion limitation
V/Q mismatch

Question 30

What tests can measure FRC?

Answer 30

Nitrogen wash out
helium wash in
body plethysmyography

Question 31

What is the normal value for oxygen carrying capacity?

Answer 31

20 mL O2/dL

Question 32

What is the normal value for oxygen delivery

Answer 32

1,000 mL O2 /min.

Question 33

What increases closing volume?

Answer 33

CLOSE-P
COPD, left ventricular failure, obesity, surgery, extreme age, pregnancy

Question 34

3 causes of primary hypercapnia include:

Answer 34

hypoventilation (decreased elimination)
increased CO2 production
rebreathing

Question 35

What are the four areas of the respiratory center?

Answer 35

dorsal respiratory group
ventral respiratory group
apneustic center
pneumotaxic center

Question 36

What is the role of the pneumotaxic center?

Answer 36

inhibitory of the dorsal respiratory group

Question 37

What is the role of the apneustic center?

Answer 37

stimulatory of the dorsal respiratory group

Question 38

What do peripheral chemoreceptors respond to?

Answer 38

decreased O2, increased CO2, increased H+

Question 39

Where are peripheral chemoreceptors located?

Answer 39

Carotid body–> glossopharyngeal nerve
aortic arch–> vagus nerve

Question 40

What things impair HPV?

Answer 40

vasodilators
dobutamine
Halogenated agents >1-1.5 MAC
Phosphodiesterase inhibitors
IV anesthetics DO NOT inhibit HPV

Question 41

What is normal DLCO?

Answer 41

17-25 mmHg

Question 42

What factors decrease DLCO?

Answer 42

decreased surface area
increased alveolar thickness

Question 43

How is smoking harmful?

Answer 43

increased SNS tone
increased risk of infection
Increased sputum production
increased carboxyhemoglobin concentration

Question 44

Short term benefits of smoking cessation include

Answer 44

SNS stimulating effects return to normal
P50 returns to near normal