Exam 2 Flashcards
1
Q
3 sever complications for adults with common cold within 2 wks preop?
A
- Cardiac arrest
- Pneumonia
- Prolonged intubation due to increase sputa
2
Q
How long should intubation be postponed after common cold in adults?
A
2 weeks
3
Q
What 4 things should you remember to do for adults common cold?
A
- Hydrate
- Reduce secretions (anti cholinergic)
- Limit airways manipulation (LMA)
- +/- bronchodilators
4
Q
Max amount of air a person can expel from the lungs after a max inhalation?
A
Vital capacity
5
Q
In restrictive lung disease, is vital capacity increased or decreased?
A
Decreased
6
Q
In obstructive lung disease, is vital capacity increased or decreased?
A
Normal to slightly decreased
7
Q
Volume of air that can forcibly be blown out in one second, after full inspiration?
A
FEV1
8
Q
Normal FEV1 values?
A
80-120%
9
Q
VC equation in female:
A
(21.78-.101a) x h
10
Q
VC equation in male:
A
(27.63-.112a) x h
11
Q
Resting volume of the lungs is the balance between what?
A
Elastic recoil pulling the lung in and chest wall out
12
Q
Obstructive lung disease FRC?
A
Increased; greater chest wall elastic recoil
13
Q
Restrictive lung disease FRC?
A
Decrease
14
Q
Obstructive lung disease mechanics:
A
Lung recoil < CW recoil
-increased resting lung volumes (TLC and FRC)
15
Q
Restrictive lung disease mechanics:
A
CW recoil < lung recoil
-decreased resting lung volume (TLC and FRC)
16
Q
Is asthma obstructive or restrictive?
A
Obstructive
17
Q
Bronchial tubes are hyperresponsive and airways become inflamed and produce excess mucus and the muscles around the airways tighten making the airways narrower?
A
Asthma
18
Q
Atopic asthma triggers?
A
Genetic tendency
19
Q
What 4 things can the OR causes asthma triggers?
A
- Allergens
- Pharamcologic agents
- Infections
- Emotional stress
20
Q
What is the abnormal autonomic regulation with asthma?
A
Mast cell release mediators which interact with ANS. Mediators directly or indirectly cause bronchoconstriction.
21
Q
How much does the maximum mid-expiratory flow (MMEF) decrease with asthma?
A
<20% of normal
22
Q
What does severe asthma V/Q mismatch leads to in PaO2?
A
<60mmHg on RA
23
Q
What does PaCO2 rises with ?
A
FEV1 <25%
24
Q
What does asthma fatigue also lead to?
A
Hypercarbia
25
What is the normal eosinophil count?
<500
26
What are the 2 rescue asthma drugs?
1. B2 adrenergic agonist
| 2. Anticholinergics
27
During acute asthma attack, does theophylline offer benefit if using inhaled B-agonist?
No
28
During acute asthma attack, what 3 things are NOT recommended?
1. Antibiotics
2. Aggressive hydration
3. Mucolytic
29
What are leukotriene modifiers?
Leukotriene receptor antagonists that are used for long-term control and prevent asthma symptoms
30
Are leukotriene modifiers quick or slow?
Work slowly
31
```
Salbutamol/albuterol
Levosalbutamol/levalbuterol
Pirbuterol
Epinephrine
Racemic epinephrine
Ephedrine
Terbutaline
```
Short acting bronchodilators
32
Which is the big gun in short acting bronchodilators?
Terbutaline
33
```
Salmeterol
Clenbuterol
Formoterol
Bambuterol
Indacaterol
```
Long acting bronchodilators
34
Does not respond to routine treatment, considered life threatening?
Status asthmaticus
35
What 5 things should be done with status asthmaticus?
1. O2 over 90%
2. B2 agonists metered dose
3. IV corticosteroids
4. Magnesium sulfate
5. Oral leukotriene inhibitors
36
What should peek expiratory flow be in preop for asthma?
>80%
37
What should be considered in emergency surgery for asthma?
Regional
38
What 5 agents have limited to no histamine release for asthma?
1. Propofol
2. Ketamine (increase secretions so give anticholinergic first)
3. Sevo
4. Fent
5. Muscle relaxants
39
What are the 3 important “L” words for asthma anesthetic maintenace?
LTA, LMA, lidocaine
40
What does an i/e ratio need to look like for asthma?
Need longer expiratory phase
41
Should you use higher or lower dose of glycopyrrolate when reversing with neostigmine?
Higher
42
Should you use steroids for acute asthma response?
No because takes awhile
43
Destroys elastic recoil, decreased bronchial wall rigidity, gas trapping, prolonged expiratory phase???
COPD
44
What color is an individual with emphysema and chronic bronchitis?
Pink for emphysema
| Blue for chronic bronchitis
45
4 things that are with chronic bronchitis?
1. Mucus hypersecretion
2. Inflammation
3. Perichonchiolar fibrosis
4. Airway obstruction
46
What does emphysema have?
Loss of elastic recoil
47
Which is more common in older individuals?
Emphysema
48
Which has early and late cough?
Early: chronic bronchitis
Late: emphysema
49
Which has early and late dyspnea?
Late: chronic bronchitis
Early: emphysema
50
What does chronic bronchitis and emphysema FEV1 look like?
Decreased
51
What does chronic bronchitis and emphysema PaO2 look like?
Chronic bronchitis: decrease
| Emphysema: increase
52
What does chronic bronchitis and emphysema PaCO2 look like?
Chronic bronchitis: increase
| Emphysema: normal to decrease
53
What does chronic bronchitis and emphysema chest x-ray look like?
Chronic bronchitis: large heart
| Emphysema: small heart
54
How do you compensate emphysema?
Hyperventilation
55
Increased or decreased CO with chronic bronchitis?
Increased
56
Why does chronic bronchitis increase CO?
Compensate for lack of O2, heart reacts by releasing adenosine, which increases CO
57
What can chronic bronchitis pts develop if given too much supplemental oxygen?
Type 2 respiratory failure
58
Low oxygen and normal or low CO2 levels
Type 1 respiratory failure
59
Low oxygen with high CO2
Type 2 respiratory failure
60
What does type 2 respiratory failure have, O2 or CO2 drive?
Hypoxic drive only
61
Stage 1: mild FEV1?
>80%
62
Stage 2: moderate FEV1?
50-80%
63
Stage 3: severe FEV1?
30-50%
64
Stage 4: very severe FEV1?
<30%
65
PaCO2 and PaO2 with chronic bronchitis?
PaCO2: >45
PaO2: <60
66
Carboxyhemoglobin shifts oxygen curve to what?
Left
67
What can 6-8 weeks of decrease in carboxygemoglobin levels and increase in P50 of oxyhemoglobin cause?
Hepatic enzymes return to normal
68
Are oral steroids recommended for stable COPD?
No
69
What can high doses of nebulized B-agonists cause in chronic bronchitis?
Tachyarrhythmia’s and hypokalemia
70
Nebulized anticholinergics can cause what in chronic bronchitis?
Increase sputum viscosity
71
4 different types of lung volume expansion maneuvers:
1. Deep breathing exercise
2. Incentive spirometry
3. Chest physical therapy
4. Positive pressure breathing techniques
72
What 3 things to do for a pneumothorax perioperatively?
1. Low pressure e
2. No PEEP
3. Increase expiratory time
73
Pulmonary arteries constrict in presence of hypoxia without hypercapnia, redirecting blood flow to alveoli with a higher oxygen content
Hypoxic pulmonary vasoconstriction
74
What is the most important factor for HPV to be depend on?
PAO2
75
Which 2 things can inhibit HPV?
Vasodilator drug
| Volatile anesthetics
76
Which drugs does not inhibit HPV?
IV anesthetics
77
11 things to inhibit hypoxic pulmonary vasoconstriction:
1. Increase CO
2. Hypothermia
3. Acidosis/alkalosis
4. Increase PVR
5. Vasodilators
6. Isoproterenol
7. CCB
8. Hypocapnia
9. PEEP
10. High frequency ventilation
11. Nitrous oxide
78
HPV functions best when of the lung being hypoxic?
30-70%
79
HPV is thought to reduce blood flow to operative lung by how much?
50%
80
What could lead to enlargement and rupture of bullae and result in development of tension pneumothorax?
Nitrous oxide
81
Ventilatory anesthetic choice for COPD: 3
Increase TV and slow breathing rate, change I:E ratio, no PEEP
82
Which dermatone region should be goal for regional anesthetic for COPD?
T10 or below
83
What should be avoided as resultant phrenic nerve palsy may further compromise respiratory function?
Interscalene block
84
Chronic necrotizing infection of bronchi and bronchioles with abnormal dilatation
Bronchiectasis
85
4 things to manage bronchiectasis:
1. Antibiotics
2. Postural drainage
3. DLT
4. No instruments of nares
86
Off-white, yellow or green, and opaque. Indicates presence of large numbers of WBCs, especially neutrophilic granulocytes.
Purulent sputum
87
Autosomal recessive genetic disorder. Abnormal transport of Cl- and Na+ across an epithelium, leading to thick, viscous secretions. Diagnosed with sweat Cl- plus cough, purulent sputum chronic pan sinusitis.
Cystic fibrosis
88
4 treatments for cystic fibrosis:
1. Bronchodilator therapy
2. Aerosol iced meds that loosen secretions
3. Dornase (human deoxyribonuclease that breaks down DNA in sputum to decrease viscosity)
4. Antibiotic therapy
89
Restrictive pulmonary disease include (3)
1. Acute intrinsic pulmonary disorders
2. Chronic intrinsic pulmonary disorders
3. Extrinsic disorders (pleura, chest wall, diaphragm, neuromuscular function)
90
What is an acute intrinsic restrictive pulmonary disease?
Pulmonary edema
91
What 2 things does acute pulmonary edema result from?
Increased capillary pressure and permeability
92
What does pulmonary edema look like on chest x-ray?
Bat wing or butterfly pattern
93
Tubular outline of an airway made visible by filling of surrounding alveoli by fluid or inflammatory exudates
Air bronchogram
94
5 characteristics of pulmonary edema:
1. Extreme dyspnea
2. Tachypnea
3. HTN
4. Tachycardia
5. Diaphoresis
95
Aspiration can result in what 3 things:
1. Atelectasis
2. Leakage of IV fluid into lungs
3. Pulmonary edema
96
Treatment of pulmonary edema (4)
1. O2
2. PEEP
3. Bronchodilation
4. Corticosteroid treatment
97
Neurogenic pulmonary edema can lead to what 3 things:
1. Vasoconstriction
2. Blood volume shift into pulmonary circulation
3. Increased pulmonary capillary pressure
98
Does naloxone speed up resolution of opioid-induced pulmonary edema?
No
99
What hts can cause altitude pulmonary edema?
8,000-16,000ft
100
What can re-expansion of collapsed lung cause?
Pulmonary edema if done too rapidly
101
When is mechanical ventilation and PEEP required of hypoxemia being present?
O2 saturation <90%
102
What should TV and RR be for intraop pulmonary edema?
TV 4-8ml/kg
| RR 14-18breaths/min
103
What is pulmonary fibrosis
Chronic intrinsic restrictive pulmonary disorder
104
Pulmonary HTN PAP and PAWP:
PAP: >25
PAWP: <15
105
Thickened alveolar membrane slows gas exchange. Loss of lung compliance may decrease alveolar ventilation.
Fibrotic lung disease
106
What is FEV1/FVC ratio of pulmonary fibrosis?
Preserved
107
What does chest x-ray look like with pulmonary fibrosis?
Ground-glass or honeycomb
108
What 5 things worsen pulmonary HTN?
1. Hypoxia
2. Hypercapnia
3. Acidosis
4. Hypothermia
5. Extreme catecholamine surges
109
Systemic granulomatous disorder most often found in interstitium
Sarcoidosis
110
Symptom of sarcoidosis:
Hypercalcemia
111
Diffuse interstitial granulomatous reactions that can lead to pulmonary fibrosis
Hypersensitivity pneumonitis
112
Excessive smooth muscle in airways, lymphatic, and blood vessels that occurs in reproductive aged females
Lymphangioleiomyomatosis (LAM)
113
4 pulmonary function tests for LAM:
1. Restrictive and obstructive disease
2. Decrease diffusing capacity
3. Decrease all volumes
4. Decrease FEV1/FEV ratio
114
Diseases due to disorders of thoracic cage which interfere with lung expansion
Chronic extrinsic restrictive lung disease
115
5 chronic extrinsic restrictive lung disease:
1. Obesity
2. Deformities of costovertberal skeletal structure
3. Deformities of sternum
4. Flail chest
5. Neuromuscular disorders
116
Swayback, spine of person curves inward at lower back
Lordosis
117
Anterior flexion of vertebral column (abnormal rounded upper back) more than 50 degree of curve
Kyphosis
118
Sideways curve to spine. S or C shape. Lateral curve with rotation of vertebral column
Scoliosis
119
Respiratory failure in kyphoscoliosis occurs when VC and degree is what?
VC <45%
| Degree >110
120
Mild to moderate kyphoscoliosis angle
<60
121
Severe kyphoscoliosis angle
>100
122
Inward con cavity of lower sternum
Precuts excavatum
123
Outward protuberance of upper, middle, or lower sternum
Pectins carinatum (pigeon chest)
124
Severe cases of pectus excavatum: 2
RA may be compressed and mitral valve prolapse
125
Ratio of transverse diameter (horizontal distance of inside of rib cage) and anteroposterior diameter (shortest distance between vertebrae and sternum)
Haller index
126
Haller index normal chest
2.5
127
Haller index considered with severe?
>3.25
128
Genetic disorder of chest wall. Makes chest jut out because of unusual growth of rib and breastbone cartilage
Pectus carinatum (pigeon chest)
129
Inward movement of unstable portion of thoracic cage while remainder of thoracic cage moves outward during inspiration (rocking horse)
Flail chest
130
Treatment for flail chest:
Positive pressure ventilation
131
What drug reverses mild degree of bronchial constriction due to increased parasympathetic tone?
Anticholinergic bronchodilating drugs
132
Sudden onset of skeletal muscle weakness or paralysis typically beginning in legs
Guillain-Barré syndrome
133
Chronic autoimmune disorder from decrease in functional AChR at NMJ
Myasthenia gravis
134
What is MG sensitive to?
Non depolarizing muscle relaxants
135
Non depolarize NMB drugs can cause prolonged paralysis or weakness
Eaton-Lambert syndrome
136
What drug to use in multiple sclerosis?
No sux and yes nondepolarizing NMB
137
Sensory levels above what can associate with impairment of respiratory muscle activity needed to maintain adequate ventilation?
T10
138
Good position for pts to breathe adequately
Sitting
139
Position for pts if have severe obstruction?
Lateral or prone
140
Adheres to lungs
Visceral pleura
141
Adheres to thoracic wall, mediastinum, and diaphragm
Parietal pleura
142
Potential space between visceral and parietal pleurae
Pleural cavity
143
Transpulmonary pressure
4
144
Intrapleural pressure
756 (-4)
145
Intra alveolar pressure
760 (0)
146
Inflammation of pleura that causes sharp pain with breathing
Pleurisy
147
Excess fluid in pleural space (thoracentesis)
Pleural effusion
148
Buildup of air or gas in pleural space
Pneumothorax
149
Visceral pleura become fibrous-surgical decortication
Pleural fibrosis
150
Central compartment of thoracic cavity. Contains all thoracic viscera and structures except lungs. Mobile region due to looseness of connective tissue and elasticity of lungs and parietal pleura
Mediastinum
151
5 symptoms of asleep pulmonary embolism:
1. Hypotension
2. Tachycardia
3. Hypoxemia
4. Decreased end tidal CO2
5. Shock and RV failure
152
Occlusion of dermal capillaries by fat emboli result in what?
Petechial rash
153
Cessation of smoking for what time causes greatest pulmonary complications?
2-4wks
154
DLCO increase or decrease in any condition which affects the affective alveolar surface area?
Decrease
155
What should be used during taping of chest in positioning lung case?
Max inflation
156
What is an overhydrated pt at risk of (2)
1. RV failure
| 2. Pulmonary edema
157
Mean pulmonary venous pressure
5
158
Pulmonary artery BP mean
15
159
When does trachea bifurcates?
T5
160
Right bronchus angle
25
161
Left bronchus angle
45
162
When does hypoxic pulmonary vasoconstriction occur?
<70
163
Acidosis and hypercapnia SVR and PVR?
Decrease SVR
| Increase PVR
164
Alkalosis and hypcapnia SVR and PVR?
Increase SVR
| Decrease PVR
165
What causes HPV?
N2O
166
Ventilated lung and non ventilated lung vent mode?
Ventilated lung PEEP
| Non ventilated lung CPAP
167
Why use atoprine, glyco before airway instrumentation?
To decreased oral secretions
168
How should atropine, glyco be given for awake airway instrumentation?
Intramuscular to avoid undesired side effects (tachycardia and psychosis)
169
All intrinsic laryngeal muscles except what are innervated by recurrent laryngeal nerve?
Cricothryroids
170
Superior laryngeal nerve block should pass about where?
2-4 mm inferior to greater Cornu of hyoid bone
171
Superior laryngeal nerve block provides where (4)
1. Base of tongue
2. Posterior surface of epiglottis
3. Aryepiglottic fold
4. Arytenoids
172
Recurrent laryngeal nerve block provides where (2)
Vocal fold and trachea
173
Does trans-tracheal block affect motor function?
No
174
What can blockade of vagus nerve lead to? (5)
1. Bradycardia
2. Systole
3. Reflex tachycardia
4. Syncope
5. Dysphasia secondary to vocal cord paralysis
