Health Ass 4: Obstructive alternative questions Flashcards

Question

What is the characteristic duration of most asthma attacks? A) Seconds to minutes B) Minutes to hours C) Hours to days D) Weeks

Answer 1

Correct Answer: B) Minutes to hours Rationale: Most asthma attacks are described as short-lived, usually lasting from minutes to hours. This information is relevant for distinguishing between typical asthma attacks and more severe conditions such as status asthmaticus, which is characterized by a prolonged, life-threatening bronchospasm.

Answer 2

Correct Answer: C) A life-threatening bronchospasm that is unresponsive to usual treatments Rationale: Status asthmaticus is a severe and dangerous condition characterized by a life-threatening bronchospasm that does not respond to standard treatments. It is an asthma emergency that requires immediate medical intervention, often in an intensive care setting.

Answer 3

Correct Answer: B) Previous intubations and hospitalizations for asthma Rationale: A patient's history of previous intubations, ICU admissions, frequency of hospitalizations for asthma in the past year, and the presence of coexisting diseases provide crucial information about the severity of the patient's asthma, their response to treatment, and the risk of future exacerbations. This assessment is essential for managing asthma and preparing for potential complications.

Answer 4

Correct Answer: D) All of the above Rationale: Eosinophilia is a condition characterized by a higher than normal level of eosinophils, a type of white blood cell. It is often associated with various asthma symptoms, including cough, chest tightness, and dyspnea. Eosinophilia in the context of asthma suggests an allergic component or a particular type of inflammation associated with the condition.

Answer 5

Correct Answer: B) Pulmonary function tests (PFTs) Rationale: The diagnosis of asthma relies on both clinical history and objective measurements of airway obstruction, which are provided by pulmonary function tests (PFTs). PFTs, including spirometry, can demonstrate airflow obstruction that is at least partially reversible with bronchodilators, a hallmark of asthma.

Answer 6

Correct Answer: B) Partially reversible with bronchodilators Rationale: The diagnosis of asthma includes the demonstration of airflow obstruction on PFTs that is at least partially reversible with the use of bronchodilators. This reversibility is a key feature that distinguishes asthma from other respiratory conditions that may not show such a response to bronchodilators.

Answer 7

Correct Answer: B) Symptoms frequency, PFT results, and medication usage Rationale: The severity of asthma is classified based on a comprehensive assessment that includes the frequency and severity of symptoms, results from PFTs, and the amount and frequency of medication usage. This classification is important for guiding treatment decisions and management strategies.

Answer 8

Correct Answer: B) Forced expiratory volume in 1 second (FEV1) Rationale: FEV1 is the volume of air that can be forcefully exhaled in one second and is a key indicator of airflow limitation, which is characteristic of obstructive lung diseases such as asthma. It is commonly used in the diagnosis and monitoring of these conditions.

Answer 9

Correct Answer: D) It suggests obstructive lung disease when reduced. Rationale: The FEV1/FVC ratio is a calculated ratio used in spirometry to differentiate between obstructive and restrictive lung disease patterns. A reduced ratio (less than the normal 75%-80% in healthy adults) is indicative of obstructive lung disease, such as asthma or chronic obstructive pulmonary disease (COPD), because it reflects a disproportionate reduction in FEV1 relative to FVC.

Answer 10

Correct Answer: C) Carbon monoxide Rationale: The diffusing capacity (DLCO) test measures how well oxygen and other gases are absorbed into the blood from the lungs. Specifically, carbon monoxide (CO) is used because it is rapidly taken up by hemoglobin, and its transfer can be measured to assess the efficiency of gas exchange in the lungs. normal is 17-25 mL/min/mmHg

Answer 11

Correct Answer: A) To measure the largest volume of air inhaled and exhaled in one minute Rationale: The MVV test measures the maximum amount of air that can be inhaled and exhaled within one minute. For patient comfort, it is typically measured over a shorter time period and extrapolated to a minute. It provides information on the endurance of the respiratory muscles and the overall capacity for sustained ventilation.

Answer 12

Correct Answer: D) FEV1 < 35% of predicted Rationale: A typical symptomatic asthmatic patient presenting to the hospital with an acute exacerbation would have an FEV1 less than 35% of the predicted value, indicating severe respiratory obstruction. This measurement is crucial in assessing the severity of an asthma attack and guiding treatment decisions.

Answer 13

Correct Answer: C) Improvement in obstruction after a bronchodilator administration Rationale: Relief of expiratory obstruction after the administration of a bronchodilator is indicative of asthma, as it suggests reversible airway obstruction, which is a hallmark of the condition. It supports the diagnosis of asthma in the context of appropriate clinical symptoms.

Answer 14

Correct Answer: B) Downward scooping of the expiratory limb Rationale: Flow-volume loops in asthmatic patients, particularly during an attack, often show a characteristic downward scooping of the expiratory limb of the loop. This pattern reflects the dynamic compression of airways that occurs during forced expiration in the presence of airway obstruction.

Answer 15

Correct Answer: C) Several days Rationale: Abnormalities in PFTs can persist for several days after an asthma attack even when clinical symptoms have subsided. This indicates that objective measures of lung function can lag behind clinical recovery and supports the need for ongoing assessment after an acute exacerbation.

Answer 16

Correct Answer: B) When PFT results are within normal limits Rationale:During moderate or severe asthma attacks, the functional residual capacity (FRC) may increase substantially, but total lung capacity (TLC) usually remains normal

Answer 17

Correct Answer: B) Normal PaO2 and PaCO2 Rationale: Mild asthma is often characterized by normal arterial blood gases, including both PaO2 (partial pressure of oxygen) and PaCO2 (partial pressure of carbon dioxide). This reflects the adequacy of ventilation and gas exchange in mild cases.

Answer 18

Correct Answer: B) Neural reflexes of the lungs Rationale: Tachypnea and hyperventilation during an acute asthma attack are usually caused by neural reflexes of the lungs rather than hypoxemia. This response can lead to hypocarbia and respiratory alkalosis, particularly in the early stages of an attack.

Answer 19

Correct Answer: C) Hypocarbia and respiratory alkalosis Rationale: In symptomatic asthma, particularly during an acute exacerbation, the common ABG findings include hypocarbia (low PaCO2) due to hyperventilation and respiratory alkalosis as the body loses CO2 faster than it is produced, leading to an increase in blood pH.

Answer 20

Correct Answer: B) 60 mmHg Rationale: As expiratory obstruction severity increases, the associated ventilation/perfusion mismatching may result in a PaO2 of less than 60 mmHg. This indicates a severe gas exchange impairment requiring urgent medical attention.

Answer 21

Correct Answer: B) Fatigue of the respiratory muscles Rationale: In severe asthma, the fatigue of the skeletal muscles necessary for breathing can contribute to the development of hypercarbia (elevated PaCO2). This occurs because the respiratory muscles can no longer compensate for the increased work of breathing, leading to inadequate ventilation. The PaC02 is likely to increase when the FEV1 is <25% of predicted

Answer 22

Correct Answer: B) Hyperinflation and hilar vascular congestion Rationale: Patients with severe asthma may exhibit chest radiographic findings of hyperinflation, characterized by flattened diaphragms and increased retrosternal air space, and hilar vascular congestion. These findings are due to air trapping and mucous plugging, which can also contribute to pulmonary hypertension (pulmonary HTN).

Answer 23

Correct Answer: B) To evaluate for signs of right ventricular (RV) strain or ventricular irritability Rationale: An EKG may be performed during an asthma attack to evaluate for signs of RV strain or ventricular irritability, which can occur due to increased pulmonary pressures from severe bronchospasm and hypoxemia. This assessment helps to detect any cardiac complications that might arise during severe respiratory distress.

Answer 24

Correct Answer: A) Pulmonary embolism Rationale: The differential diagnosis of asthma typically includes conditions that present with similar respiratory symptoms such as wheezing or airflow obstruction. These can include viral tracheobronchitis, sarcoidosis, rheumatoid arthritis with bronchitis, airway compression, vocal cord dysfunction, tracheal stenosis, chronic bronchitis, COPD, and foreign body aspiration. Pulmonary embolism, while it can cause shortness of breath, is not typically confused with asthma because it presents with different clinical and diagnostic findings.

Answer 25

Correct Answer: D) The cause of an asthma exacerbation and ruling out other causes Rationale: A CXR can be instrumental in determining the cause of an asthma exacerbation by identifying any complications or alternate diagnoses that might present with similar symptoms, such as pneumonia or pneumothorax, and thereby ruling out other causes of respiratory distress.

Answer 26

Correct Answer: B) Pulmonary hypertension Rationale: During a severe asthma attack, increased resistance to airflow can lead to elevated pressure in the pulmonary circulation, potentially causing pulmonary hypertension. This condition may result in right ventricular strain, which can be detected on an EKG.

Answer 27

Correct Answer: B) Short-acting inhaled β2 agonists Rationale: A short-acting inhaled β2 agonist is recommended as the first-line treatment for patients with mild asthma, particularly for those experiencing less than two exacerbations per month. This treatment rapidly relaxes bronchial smooth muscle and provides quick relief of symptoms.

Answer 28

Correct Answer: B) When there are more than two exacerbations per month despite a short-acting β2 agonist Rationale: Daily inhaled corticosteroids are added to the treatment regimen when asthma symptoms are not well-controlled with a short-acting β2 agonist alone, which is often indicated by more than two exacerbations per month. Inhaled corticosteroids work by reducing airway inflammation, thus improving symptoms and decreasing the risk of future exacerbations.

Answer 29

Correct Answer: B) Systemic corticosteroids Rationale: Systemic corticosteroids are reserved for cases of severe asthma that remain uncontrolled with inhalational medications. They are potent anti-inflammatory agents that can help control severe and persistent asthma symptoms and prevent exacerbations.

Answer 30

Correct Answer: B) It decreases the use of long-term medications and may improve the quality of life. Rationale: SQ immunotherapy can decrease the need for long-term medications in some patients with asthma by modifying the immune response to allergens. Over time, this treatment may lead to an improvement in asthma symptoms and the overall quality of life for patients with allergen-driven asthma.

Answer 31

Correct Answer: B) Inhaled muscarinic antagonists, leukotriene modifiers, and mast cell stabilizers Rationale: Other therapies used in the management of asthma may include inhaled muscarinic antagonists, which act as bronchodilators; leukotriene modifiers, which reduce inflammation; and mast cell stabilizers, which prevent the release of histamine and other mediators from mast cells. These are considered when symptoms persist despite the use of β2 agonists and corticosteroids.

Answer 32

Correct Answer: B) A nonpharmacologic treatment used in refractory asthma Rationale: Bronchial thermoplasty (BT) is a recently approved nonpharmacologic treatment option for patients with refractory asthma who do not respond to standard treatments. It uses bronchoscopy to deliver radiofrequency ablation to the airway smooth muscles, reducing their mass and thus the ability to constrict, leading to fewer symptoms.

Answer 33

Correct Answer: C) In three sessions excluding the right middle lobe Rationale: BT is performed in three sessions and targets all lung fields except the right middle lobe. The division into three sessions allows for a controlled approach to reduce the risk of complications and manage potential side effects, such as transient exacerbation of symptoms.

Answer 34

Correct Answer: C) Airway fire due to the use of intense heat Rationale: Bronchial thermoplasty involves the application of intense heat to the airway smooth muscles, which carries an inherent risk of airway fire. This is a rare but serious complication, hence the careful monitoring during the procedure.

Answer 35

Correct Answer: B) Reduce bronchoconstriction Rationale: The loss of airway smooth muscle mass as a result of BT is thought to reduce bronchoconstriction. By decreasing the amount of muscle available to constrict the airways, BT can help in alleviating the severity and frequency of asthma symptoms.

Answer 36

Correct Answer: B) About 50% of normal Rationale: When the FEV1 improves to about 50% of normal following BT, patients usually experience minimal or no symptoms. This level of improvement signifies a significant positive response to the treatment, indicating its efficacy in reducing asthma-related airflow obstruction.

Answer 37

Correct Answer: B) High-dose, short-acting β2 agonists and systemic corticosteroids Rationale: In acute severe asthma, emergency treatment typically includes high doses of short-acting β2 agonists to rapidly relax bronchial smooth muscle and systemic corticosteroids to reduce inflammation. This combination is critical for managing life-threatening bronchospasm.

Answer 38

Correct Answer: C) They can be administered frequently without adverse hemodynamic effects. Rationale: Inhaled β2 agonists are preferred because they can be administered frequently (every 15-20 minutes for several doses) without causing adverse hemodynamic effects, though patients may still experience sensations of adrenergic overstimulation. The inhaled route provides direct delivery to the lungs, leading to a rapid onset of bronchodilation with fewer systemic effects compared to oral or intravenous administration.

Answer 39

Correct Answer: A) Immediately on presentation Rationale: Intravenous corticosteroids are administered early in the treatment of acute severe asthma because their onset of action takes several hours. Early initiation ensures that the anti-inflammatory effects are underway as soon as possible, as they are essential for managing severe inflammation associated with acute severe asthma.

Answer 40

Correct Answer: C) Hydrocortisone and methylprednisolone Rationale: The two corticosteroids most commonly used in the emergency management of acute severe asthma are hydrocortisone and methylprednisolone. These medications are selected for their effectiveness in reducing airway inflammation when rapid action is needed.

Answer 41

Correct Answer: A) Oral leukotriene inhibitors Rationale: Other drugs used in more severe cases of asthma include magnesium, which can relax the bronchial smooth muscles, and oral leukotriene inhibitors, which block the effects of leukotrienes and further reduce inflammation within the airways.

Answer 42

Correct Answer: C) SaO2 ≥ 90% Rationale: Supplemental oxygen is administered to maintain an oxygen saturation (SaO2) of ≥90%. This level ensures adequate tissue oxygenation while avoiding the potential harmful effects of hyperoxia, particularly oxygen toxicity.

Answer 43

Correct Answer: C) When PaCO2 > 50 mm Hg Also, use Sevo- Potent Bronchodilator Rationale: Tracheal intubation and mechanical ventilation may be considered in acute severe asthma when PaCO2 exceeds 50 mm Hg, which indicates respiratory failure. Mechanical ventilation is used to support the patient's breathing until the acute phase of the exacerbation is under control.

Answer 44

Correct Answer: C) It is administered to reduce airway smooth muscle constriction. Rationale: Anticholinergic medications, such as ipratropium bromide, are inhaled to reduce airway smooth muscle constriction. They block the action of acetylcholine, a neurotransmitter that causes bronchoconstriction, thus aiding in opening the airways during an asthma attack.

Answer 45

Correct Answer: D) To avoid barotrauma from high ventilatory pressures Rationale: Permissive hypercarbia involves allowing higher than normal levels of carbon dioxide (hypercarbia) during mechanical ventilation to avoid the high pressures necessary to achieve normal CO2 levels, which could lead to barotrauma (lung injury due to overdistension).

Answer 46

Correct Answer: B) Extracorporeal membrane oxygenation (ECMO) Rationale: Extracorporeal membrane oxygenation (ECMO) may be used as a last resort treatment for acute severe asthma when all conventional therapies have failed. ECMO provides cardiac and respiratory support by oxygenating the patient's blood outside the body, allowing the lungs to rest and recover from severe exacerbation.

Answer 47

Correct Answer: B) 0.2-4.2% Rationale: Bronchospasm during general anesthesia is a known risk for asthmatic patients, with reported incidences ranging from 0.2% to 4.2%. It is a potentially serious complication that requires prompt recognition and treatment.

Answer 48

Correct Answer: C) Upper abdominal and oncologic surgery Rationale: The risk of bronchospasm in asthmatic patients undergoing general anesthesia is correlated with the type of surgery, being higher with upper abdominal and oncologic surgeries. This may be due to the proximity of the surgical site to the respiratory structures and the potential for reflex-mediated bronchospasm.

Answer 49

Correct Answer: B) Depression of cough reflex and reduction of palatopharyngeal muscle tone Rationale: General anesthesia can increase airway resistance through several mechanisms, including depression of the cough reflex, impairment of mucociliary function, reduction of palatopharyngeal muscle tone, depression of diaphragmatic function, and increased fluid in the airway wall. These effects can contribute to increased difficulty in breathing and risk of bronchospasm.

Answer 50

Correct Answer: B) Neostigmine Rationale: Neostigmine, a medication used to reverse the effects of non-depolarizing muscle relaxants, can stimulate the parasympathetic nervous system, leading to bronchoconstriction. For asthmatic patients, this can increase the risk of bronchospasm, particularly upon emergence from anesthesia.

Answer 51

Correct Answer: A) The more time that has passed since the last attack, the lower the risk. Rationale: The risk of bronchospasm during general anesthesia is correlated with how recent the last asthma attack occurred. The closer in time a surgery is to a recent asthma exacerbation, the higher the risk of intraoperative bronchospasm, as the airways may still be inflamed and hyperresponsive.

Answer 52

Correct Answer: B) To assess the degree of airway inflammation Rationale: Eosinophil counts are often reflective of the degree of airway inflammation in asthmatic patients. High levels of eosinophils can indicate increased inflammation, which may affect the management of asthma perioperatively.

Answer 53

Correct Answer: B) Risk for perioperative respiratory complications Rationale: A reduction in FEV1 or FVC to less than 70% of predicted, or an FEV1:FVC ratio less than 65% of predicted, suggests significant airflow limitation and is considered a risk for perioperative respiratory complications. It indicates that the patient's asthma may not be well-controlled, which can increase the risk of bronchospasm and other respiratory issues during surgery.

Answer 54

Correct Answer: B) Symptom control and history of exacerbations Rationale: During preoperative assessment, it's important to note the history of symptom control, frequency of exacerbations, and any need for hospitalization or intubation, as well as previous tolerance to anesthesia. This information helps in predicting the risk of perioperative asthma complications and in planning anesthesia management.

Answer 55

Correct Answer: C) It is performed to detect wheezing or crepitations indicative of current asthma control. Rationale: Auscultation of the chest is an important part of the preoperative respiratory assessment for asthmatic patients. Detecting wheezing or crepitations can provide insight into the current level of asthma control and the presence of active airway inflammation or obstruction, which can influence anesthetic management.

Answer 56

Correct Answer: B) To determine the baseline lung function and reversibility of airway obstruction Rationale: Preoperative PFTs, especially FEV1, are used to assess baseline lung function and determine the reversibility of airway obstruction with a bronchodilator. This helps in evaluating the severity of asthma and the effectiveness of the patient's current treatment regimen, which is crucial for perioperative planning.

Answer 57

Correct Answer: A) Chest physiotherapy, antibiotics, and bronchodilators Rationale: Chest physiotherapy can aid in mobilizing secretions, antibiotics may be indicated if there is a suspicion of respiratory infection, and bronchodilators help improve airflow—these interventions target reversible components of asthma and optimize the patient's respiratory status preoperatively.

Answer 58

Correct Answer: B) When there is a question about the adequacy of ventilation or oxygenation Rationale: ABGs are indicated in the preoperative assessment of asthma patients when there is any question regarding the adequacy of ventilation or oxygenation. ABGs provide direct measurement of oxygenation status, carbon dioxide levels, and blood acidity, which can inform the anesthetic plan and need for perioperative respiratory support.

Answer 59

Correct Answer: C) They should be continued until induction of anesthesia. Rationale: Anti-inflammatory medications and bronchodilators are integral to controlling asthma and should be continued right up until the induction of anesthesia to ensure that the patient's asthma is as well-managed as possible going into surgery.

Answer 60

Correct Answer: B) Administration of a stress-dose of hydrocortisone or methylprednisolone Rationale: For patients who have been on systemic corticosteroids in the past six months, administration of a stress dose of hydrocortisone or methylprednisolone is indicated preoperatively. This is because recent corticosteroid use may have suppressed the patient's adrenal function, and additional steroids may be needed to cope with the stress of surgery.

Answer 61

Correct Answer: C) Patients should be free of wheezing and have a PEFR of ≥80% of predicted or their personal best value. Rationale: Before surgery, asthmatic patients should ideally be free of wheezing and have a peak expiratory flow rate (PEFR) of ≥80% of predicted or their personal best value. These criteria indicate that the asthma is well-controlled, which minimizes the risk of perioperative respiratory complications.

Answer 62

Correct Answer: C) 10% Rationale: COPD has a worldwide prevalence of 10%, affecting a significant proportion of the adult population. This highlights the importance of COPD as a major public health concern and its impact on morbidity and mortality globally.

Answer 63

Correct Answer: C) Third Rationale: COPD is the third leading cause of death worldwide. This statistic emphasizes the severity of the disease and its significant impact on global health.

Answer 64

Correct Answer: C) Occupational exposure to dust and chemicals Rationale: In addition to cigarette smoking, other risk factors for COPD include occupational exposure to dust and chemicals, asbestos exposure, gold mining, biomass fuel use, air pollution, genetic factors, age, female gender, poor lung development during gestation, low birth weight, recurrent childhood respiratory infections, low socioeconomic class, and pre-existing asthma.

Answer 65

Correct Answer: C) Loss of pulmonary elastic recoil due to bronchio-alveolar destruction Rationale: COPD is characterized by the loss of pulmonary elastic recoil due to bronchio-alveolar destruction, leading to chronic airflow obstruction. This loss of recoil impairs the lungs' ability to expel air, contributing to the symptoms and complications associated with the disease.

Answer 66

Correct Answer: C) Productive cough Rationale: COPD symptoms typically include a productive cough, which is a cough that produces phlegm. This is due to the chronic bronchitis component of the disease, which involves inflammation of the bronchi and increased mucus production.

Answer 67

Correct Answer: C) Pathologic deterioration in elasticity or recoil Rationale: COPD leads to a pathologic deterioration in the elasticity or recoil within the lung parenchyma. Normally, this elasticity helps keep the airways open, but the loss of recoil in COPD causes the airways to collapse more easily, contributing to airflow obstruction.

Answer 68

Correct Answer: C) Decrease in bronchiolar wall structure Rationale: COPD is associated with pathologic changes that decrease bronchiolar wall structure, reducing their ability to stay open during exhalation and thus contributing to collapse. This change impairs the air flow, especially during the exhalation phase of breathing.

Answer 69

Correct Answer: C) Increases velocity due to narrowed airways Rationale: COPD leads to increased velocity through the narrowed bronchioles, which lowers intrabronchial pressure and favors airway collapse. This is explained by the Venturi effect, where the velocity of a fluid (in this case, air) increases as it passes through a narrow space, leading to a decrease in pressure.

Answer 70

Correct Answer: B) Increased pulmonary secretions Rationale: Active bronchospasm and obstruction in COPD result from increased pulmonary secretions. These secretions can block the narrowed airways, contribute to inflammation, and exacerbate the difficulty in breathing characteristic of the disease.

Answer 71

Correct Answer: B) Enlargement of alveolar air sacs Rationale: Emphysema, a type of COPD, involves the destruction of lung parenchyma, leading to enlarged air sacs. This enlargement impairs gas exchange and reduces the lung's ability to recoil, which further contributes to the obstructive symptoms of the disease.

Answer 72

Correct Answer: B) Dyspnea Rationale: Dyspnea, or shortness of breath, is a hallmark symptom of COPD that occurs at rest or with exertion, and its presence is generally irrespective of the disease's severity. It is due to airflow obstruction, which is a fundamental characteristic of COPD.

Answer 73

Correct Answer: C) Acute worsening in airflow obstructions Rationale: COPD exacerbations are characterized by acute worsening of airflow obstructions. This leads to increased shortness of breath, cough, and production of sputum, and often necessitates medical intervention or changes in treatment regimen.

Answer 74

Correct Answer: C) Tachypnea and prolonged expiratory times Rationale: As expiratory obstruction in COPD increases, patients often develop tachypnea (rapid breathing) and prolonged expiratory times, reflecting the increased effort required to breathe against obstructed airways.

Answer 75

Correct Answer: C) Decreased breath sounds and expiratory wheezes Rationale: In COPD patients, breath sounds are typically decreased due to hyperinflation of the lungs, and expiratory wheezes are common, indicating airway narrowing and obstruction. These sounds can be more pronounced during exacerbations.

Answer 76

Correct Answer: B) Bacterial respiratory infections Rationale: Exacerbations in COPD, especially as the disease progresses, are often triggered by bacterial respiratory infections. These infections can further compromise the already limited lung function in COPD patients, leading to acute worsening of symptoms.

Answer 77

Correct Answer: C) Spirometry Rationale: The definitive diagnosis of COPD is made with spirometry, a pulmonary function test that measures the volume of air an individual can exhale in a specific time period and the total volume of air they can exhale after taking the deepest breath possible.

Answer 78

Correct Answer: C) Obstructive lung disease Rationale: A decrease in the FEV1:FVC ratio is characteristic of obstructive lung diseases like COPD. It reflects a disproportionate reduction in the forced expiratory volume in the first second (FEV1) compared to the forced vital capacity (FVC), which is a hallmark of airflow limitation.

Answer 79

Correct Answer: B) FEV1:FVC ratio <70% Rationale: In patients with COPD, common spirometric findings include an FEV1:FVC ratio of less than 70%, which indicates airflow limitation, along with a decreased forced expiratory flow between 25% and 75% of vital capacity, which measures the flow of air coming out of the lung during the middle portion of exhalation.

Answer 80

Correct Answer: C) Due to slow expiratory airflow and gas trapping Rationale: An increase in residual volume (RV) in COPD patients occurs due to slow expiratory airflow and gas trapping behind prematurely closed airways. This leads to air being trapped in the lungs at the end of a full expiration, increasing the RV.

Answer 81

Correct Answer: D) They will experience greater effort and energy expenditure while breathing. Rationale: The increased work of breathing at higher lung volumes for COPD patients implies that they must exert more effort and energy to breathe. The loss of elastic recoil and airflow obstruction leads to hyperinflation, which makes breathing more labor-intensive and inefficient.

Answer 82

Correct Answer: D) Very severe Rationale: The GOLD Spirometric Criteria for COPD severity categorize a postbronchodilator FEV1 of less than 30% predicted as Stage IV, which is defined as very severe COPD. This stage is associated with the greatest airflow limitation and typically correlates with more significant symptoms and increased risk of exacerbations.

Answer 83

Correct Answer: B) Moderate COPD

Answer 84

Correct Answer: B) The patient has mild COPD.

Answer 85

Correct Answer: C) It raises the COPD severity classification. Rationale: An increased RV is due to air trapping and is one of the spirometric indicators of the obstruction in COPD. While RV itself is not directly used in the GOLD criteria for severity classification, increased RV alongside reduced FEV1 can indicate a more severe classification. The higher the RV in proportion to TLC (RV:TLC ratio), the more severe the obstructive impairment is likely to be, which can contribute to a higher COPD severity classification according to the FEV1 values outlined in the GOLD criteria.

Answer 86

Correct Answer: B) Hyperlucency in the lung periphery Rationale: Hyperlucency in the lung periphery on a CXR suggests emphysema in COPD patients. This radiologic sign indicates areas of the lung where the tissue is less dense, typically due to the destruction of alveolar walls seen in emphysema.

Answer 87

Correct Answer: B) CT is much more sensitive at diagnosing COPD. Rationale: CT scans are much more sensitive than CXRs at diagnosing COPD because they provide detailed images that can better depict the structural changes in the lungs associated with the disease. While CT is not routinely used for COPD diagnosis due to higher cost and radiation exposure, it can offer additional information that can influence the management of the disease.

Answer 88

Correct Answer: B) Confirms emphysema Rationale: Bullae on a CXR confirm the presence of emphysema. Bullae are large air-filled spaces within the lung parenchyma resulting from the destruction of alveolar walls, a characteristic feature of emphysema, one of the components of COPD.

Answer 89

Correct Answer: C) A variety of systemic manifestations including higher rates of lung cancer Rationale: The Multiorgan Loss of Tissue (MOLT) phenotype of COPD is associated with systemic effects beyond the lungs, such as airspace enlargement, alveolar destruction, and loss of bone, muscle, and fat tissues. Patients with this phenotype also carry higher rates of lung cancer.

Answer 90

Correct Answer: C) Metabolic syndrome and cardiac disease Rationale: The bronchitic phenotype of COPD, characterized by bronchiolar narrowing and wall thickening, is commonly associated with systemic conditions such as metabolic syndrome and cardiac disease. This highlights the systemic nature of COPD and its association with comorbidities that can significantly affect the overall health and prognosis of affected individuals.

Answer 91

Correct Answer: C) Prognosis based on various clinical factors Rationale: The BODE index is a multidimensional grading system that assesses prognosis in COPD patients by considering body mass index (BMI), degree of airway obstruction, dyspnea levels, and exercise tolerance. Higher BODE scores are linked with a greater risk of exacerbations, hospitalizations, and mortality.

Answer 92

Correct Answer: C) When FEV1 is <50% of predicted Rationale: In COPD, arterial oxygen tension (PaO2) typically doesn't decrease until the forced expiratory volume in 1 second (FEV1) falls below 50% of the predicted value, which indicates more advanced disease and significant impairment of pulmonary function.

Answer 93

Correct Answer: B) Requirement for lifelong replacement therapy Rationale: α1-antitrypsin deficiency is an inherited disorder associated with COPD. Low levels of this enzyme can lead to uncontrolled protease activity in the lungs, resulting in lung damage and emphysema. Lifelong replacement therapy is required to manage this deficiency and prevent further pulmonary deterioration.

Answer 94

Correct Answer: B) Need for inhaled glucocorticoids Rationale: High eosinophil counts in COPD patients who are not adequately controlled with bronchodilator treatment indicate inflammation and may suggest a need for inhaled glucocorticoids to better manage the disease.

Answer 95

Correct Answer: C) When FEV1 is <50% of predicted and even lower Rationale: An increase in arterial carbon dioxide tension (PaCO2) usually occurs when FEV1 is below 50% of predicted and continues to worsen as the disease progresses, reflecting hypoventilation and ventilation-perfusion mismatching that worsens with the severity of the disease.

Answer 96

Correct Answer: B) Alleviate symptoms and slow disease progression Rationale: COPD treatment aims to alleviate symptoms such as dyspnea and cough and to slow the progression of the disease. While there is no cure for COPD, these management strategies can improve quality of life and functional status.

Answer 97

Correct Answer: B) Long-acting inhaled muscarinic antagonists Rationale: Treatment for COPD often begins with long-acting inhaled muscarinic antagonists, which help to relax the muscles around the airways, making it easier to breathe and helping to prevent symptoms.

Answer 98

Correct Answer: C) 18% Rationale: Smoking cessation is a critical step in managing COPD and can decrease disease progression and lower mortality by up to 18%. Quitting smoking can have immediate and long-term benefits for lung function and overall health.

Answer 99

Correct Answer: C) Inhaled glucocorticoids Rationale: 3rd line treatment.. Inhaled glucocorticoids are most effective for COPD patients who also have associated asthma, rhinitis, elevated eosinophils, and a history of frequent exacerbations. They work by reducing airway inflammation and are an essential part of managing COPD with these specific comorbidities.

Answer 100

Correct Answer: A) Long-acting β2 agonist Rationale: 2nd line.. If dyspnea persists in a COPD patient despite the use of long-acting muscarinic antagonists, long-acting β2 agonists can be added. These medications help to further dilate the airways and reduce symptoms of breathlessness.

Answer 101

Correct Answer: B) Pulmonary rehabilitation programs Rationale: Pulmonary rehabilitation programs are a non-pharmacological approach that can significantly benefit COPD patients by increasing their exercise capacity and improving their overall quality of life through tailored exercise, education, and support.

Answer 102

Correct Answer: B) To reduce plasma volume and alleviate fluid congestion Rationale: Diuretics are prescribed in the case of RHF or CHF to reduce plasma volume, which helps alleviate fluid congestion and edema commonly seen in heart failure, thereby improving cardiac function and potentially relieving some of the cardiopulmonary symptoms associated with COPD.

Answer 103

Correct Answer: A) Antibiotics, corticosteroids, and theophylline Rationale: During COPD exacerbations, antibiotics may be prescribed if there's a bacterial infection, corticosteroids are used to reduce inflammation, and theophylline may be used as a bronchodilator to relieve airway constriction, although its use has declined in favor of newer, more effective therapies with better safety profiles.

Answer 104

Correct Answer: B) Flu and pneumonia vaccinations Rationale: Preventive measures such as flu and pneumonia vaccinations are important components of COPD treatment. These vaccinations are recommended to reduce the risk of respiratory infections that can lead to exacerbations of COPD, which can significantly impact morbidity and mortality in these patients.

Answer 105

Correct Answer: C) They improve symptoms, improve FEV1, and reduce exacerbations. Rationale: Inhaled treatments, such as bronchodilators and corticosteroids, are mainstays in COPD management because they improve respiratory symptoms, enhance lung function as measured by FEV1, and reduce the frequency and severity of exacerbations.

Answer 106

Correct Answer: C) PaO2 < 55mmHg or HCT >55% Rationale: Long-term home oxygen therapy is indicated for COPD patients with a PaO2 of less than 55mmHg or a hematocrit greater than 55%, which suggest significant hypoxemia and secondary polycythemia due to chronic hypoxia, respectively. It is also recommended if there is evidence of cor pulmonale, which is right-sided heart failure due to lung disease.

Answer 107

Correct Answer: B) To achieve a PaO2 > 60 mmHg Rationale: The main goal of supplemental oxygen in COPD is to raise the partial pressure of arterial oxygen (PaO2) to above 60 mmHg. This level can typically be achieved with a nasal cannula at 2 liters per minute, improving systemic oxygenation and preventing complications of chronic hypoxemia.

Answer 108

Correct Answer: C) With a nasal cannula at 2 L/min Rationale: Supplemental oxygen is often administered to COPD patients via a nasal cannula at a rate of 2 liters per minute, which is a starting point to achieve the target PaO2 of >60 mmHg. The exact flow rate can be adjusted based on arterial blood gas (ABG) results or pulse oximetry (SpO2) readings.

Answer 109

Correct Answer: C) It decreases pulmonary vascular resistance and prevents erythrocytosis. Rationale: Supplemental oxygen is more effective than drug therapy in decreasing pulmonary vascular resistance and pulmonary hypertension, which are consequences of chronic hypoxemia in COPD. Oxygen therapy also helps prevent erythrocytosis, which is the overproduction of red blood cells in response to low oxygen levels.

Answer 110

Correct Answer: B) Deep breathing exercises or incentive spirometry Rationale: Patients with COPD should be advised to perform deep breathing exercises or use incentive spirometry, especially postoperatively. These exercises can help improve respiratory mechanics, clear secretions, and potentially reduce the risk of postoperative pulmonary complications.

Answer 111

Correct Answer: B) Those with severe refractory COPD and overdistended lung tissue Rationale: LVRS is considered for patients with severe refractory COPD who have overdistended lung tissue. The surgery can remove these overdistended areas, allowing the remaining healthier lung tissue to function better and improving overall respiratory mechanics.

Answer 112

Correct Answer: C) Increased elastic recoil and improved diaphragmatic function Rationale: Following LVRS, expected improvements in lung function include increased elastic recoil, which helps expiratory airflow, decreased hyperinflation, which improves diaphragmatic and chest wall mechanics, and decreased ventilation/perfusion mismatch, which enhances alveolar gas exchange.

Answer 113

Correct Answer: B) Double-lumen ETT and avoidance of nitrous oxide Rationale: Anesthesia management for LVRS typically involves using a double-lumen endotracheal tube (ETT) to allow for single-lung ventilation, which facilitates the surgical process. Nitrous oxide is avoided due to its potential to increase hyperinflation and air trapping, and care is taken to minimize excessive airway pressures to prevent barotrauma.

Answer 114

Correct Answer: B) Surgical alterations can affect intrathoracic pressures, making CVP readings unreliable. Rationale: CVP is an unreliable guide for fluid management during LVRS because surgical alterations, such as the resection of lung tissue and changes in chest cavity pressures, can significantly affect intrathoracic pressures. Consequently, CVP readings may not accurately reflect the true volume status or cardiac filling pressures.

Answer 115

Correct Answer: C) To allow more areas of normal lung to expand and improve lung function Rationale: The primary goal of removing overdistended lung areas through LVRS is to allow the more normal, healthier areas of the lung to expand and function more effectively. This can lead to improved breathing mechanics, exercise capacity, and quality of life for the patient.

Answer 116

Correct Answer: C) To maintain optimal pulmonary function preoperatively. Rationale: Inhalation therapies, which typically include bronchodilators and corticosteroids, are continued until the morning of surgery in COPD patients to maintain optimal pulmonary function, reduce bronchospasm, and minimize airway reactivity preoperatively.

Answer 117

Correct Answer: B) Right ventricular function via clinical exam and echocardiogram Rationale: Assessment of right ventricular function is crucial for COPD patients prior to anesthesia due to the potential for pulmonary hypertension leading to cor pulmonale. A clinical exam and echocardiogram can evaluate right ventricular size, function, and pulmonary artery pressures.

Answer 118

Correct Answer: B) History of smoking, wheezing, and productive cough Rationale: Clinical findings such as a history of smoking, wheezing, and a productive cough are more predictive of postoperative pulmonary complications than spirometric values. These findings provide insights into the patient's respiratory status and potential challenges during and after surgery.

Answer 119

Correct Answer: D) PFTs may not alter management or predict postoperative outcomes better than clinical findings. Rationale: The value of routine preoperative PFTs is controversial because they may not provide additional information that alters anesthetic management or predicts postoperative outcomes better than clinical findings, which include an assessment of symptoms and physical examination.

Answer 120

Correct Answer: B) DM, HTN, PVD, ischemic heart disease, heart failure, dysrhythmias, and lung cancer Rationale: COPD is often associated with multiple comorbidities. Therefore, it is important to question and manage related conditions such as diabetes mellitus (DM), hypertension (HTN), peripheral vascular disease (PVD), ischemic heart disease, heart failure, dysrhythmias, and lung cancer during preoperative assessment to optimize perioperative care and outcomes.

Answer 121

Correct Answer: C) History of respiratory failure due to an existing problem Rationale: A history of respiratory failure due to an existing problem is an indication for preoperative pulmonary evaluation because it increases the risk of perioperative respiratory complications, requiring a thorough assessment to optimize patient management.

Answer 122

Correct Answer: C) When there is uncertainty about the extent of lung disease Rationale: In cases where there is doubt about the severity or extent of lung disease in COPD patients, spirometry with FEV1 measurement can be a simple yet effective tool to assess pulmonary function and guide preoperative planning.

Answer 123

Correct Answer: B) When undergoing peripheral surgery Rationale: Patients with COPD who are undergoing peripheral surgery generally do not require preoperative PFTs because the risk of respiratory complications is lower than with surgeries involving the thorax or upper abdomen.

Answer 124

Correct Answer: A) Suspected pulmonary hypertension (HTN) Rationale: Suspected pulmonary hypertension is a specific indication for preoperative pulmonary evaluation, as it can significantly impact anesthesia management and surgical outcomes. Accurate assessment and management of pulmonary HTN are crucial to reduce perioperative risks.

Answer 125

Correct Answer: C) Possible undiagnosed respiratory disease or respiratory compromise Rationale: A PCO2 level greater than 50 mmHg without an already diagnosed pulmonary disease could suggest an undiagnosed condition or respiratory compromise. It is an indication for further evaluation to determine the cause of hypercapnia and to manage any underlying respiratory dysfunction. or bicarb > 33mEq/L

Answer 126

Correct Answer: C) U-shaped Rationale: During maximal inspiration from RV to TLC, the inspiratory flow is most rapid at the midpoint of inspiration, causing a U-shaped inspiratory curve on the flow-volume loop. This is a typical pattern seen during forceful breathing efforts.

Answer 127

Correct Answer: C) Lower than normal Rationale: In patients with COPD, the expiratory flow rate at any given lung volume is lower than normal. This is due to the obstruction in the airways, which restricts the flow of air out of the lungs.

Answer 128

Correct Answer: C) Uniform emptying of the airways Rationale: The expiratory curve in COPD patients is concave due to uniform emptying of the airways, which is slower than in healthy lungs. This is caused by narrowed airways and the loss of elastic recoil in the lung tissue, leading to decreased flow rates, especially during forced expiration.

Answer 129

Correct Answer: B) It reflects restricted airflow due to air trapping. Rationale: An increased RV in COPD reflects restricted airflow due to air trapping. Air trapping occurs when air gets caught in the lungs during expiration due to obstructed or narrowed airways, common in COPD, leading to hyperinflation and increased RV.

Answer 130

Correct Answer: C) Class III or higher Rationale: An ASA classification higher than II (i.e., Class III or higher) indicates a patient with more severe systemic disease, which is associated with a higher risk for postoperative pulmonary complications due to less physiological reserve and the potential for more complex medical management.

Answer 131

Correct Answer: C) Preexisting pulmonary disease, like COPD Rationale: A preexisting pulmonary disease such as chronic obstructive pulmonary disease (COPD) is a major patient-related risk factor for the development of postoperative pulmonary complications due to compromised respiratory function.

Answer 132

Correct Answer: D) Prolonged duration of anesthesia (≥2.5 hours) Rationale: A prolonged duration of anesthesia, defined as 2.5 hours or longer, is a procedure-related risk factor for postoperative pulmonary complications, likely due to extended periods of immobility, potential for more significant surgical stress, and longer exposure to anesthetic agents.

Answer 133

Correct Answer: A) <3.5 g/dL Rationale: An albumin level of less than 3.5 g/dL is a test predictor for the development of postoperative pulmonary complications. Low albumin can indicate poor nutritional status, which is associated with decreased tissue healing and immune response, increasing the risk of complications.

Answer 134

Correct Answer: B) Cosmetic surgery Rationale: Cosmetic surgery is not typically associated with a higher risk of postoperative pulmonary complications compared to more invasive procedures like abdominal surgery, emergency surgery, or vascular/aortic aneurysm surgery, which require longer anesthesia duration and may have greater impacts on respiratory function.

Answer 135

Correct Answer: A) At least 6 weeks Rationale: Preoperative cessation of smoking for at least 6 weeks is recommended to reduce the risk of postoperative complications. This time frame allows for improvement in mucociliary clearance, reduced carboxyhemoglobin levels, and overall better respiratory function.

Answer 136

Correct Answer: A) Use of endoscopic techniques when possible Rationale: Using minimally invasive surgery, such as endoscopic techniques, when possible, is an intraoperative strategy to minimize the risk of postoperative complications. These techniques typically involve smaller incisions, less pain, and quicker recovery times, which can help reduce pulmonary complications.

Answer 137

Correct Answer: C) Bed rest without movement Rationale: Bed rest without movement is not a lung volume expansion maneuver and can actually increase the risk of postoperative pulmonary complications. Voluntary deep breathing, incentive spirometry, and CPAP are all techniques used to promote lung expansion and prevent atelectasis after surgery.

Answer 138

Correct Answer: A) Neuraxial opioids Rationale: Neuraxial opioids, such as those administered via an epidural or spinal route, can provide effective pain relief while minimizing the respiratory depression often seen with systemic opioids. Adequate pain control can facilitate patient participation in respiratory exercises and reduce the risk of pulmonary complications.

Answer 139

Correct Answer: C) They are associated with an increased risk of postoperative pulmonary complications. Rationale: Surgical procedures with prolonged durations, particularly those exceeding 3 hours, are associated with an increased risk of postoperative pulmonary complications. Extended periods of anesthesia and immobility can lead to atelectasis, impaired mucociliary function, and respiratory muscle dysfunction.

Answer 140

Correct Answer: D) 8 weeks Rationale: The maximum benefit of smoking cessation is generally not observed unless smoking is stopped at least 8 weeks prior to surgery. This period allows for significant physiological recovery of the respiratory mucosa and improvement in ciliary function.

Answer 141

Correct Answer: B) 5-10% Rationale: 5-10% of smokers undergo GA annually, which offers healthcare providers a significant opportunity to intervene and encourage patients to quit smoking, thereby reducing the risk of perioperative complications.

Answer 142

Correct Answer: B) 4-6 hours Rationale: The elimination half-life of carbon monoxide, a component of cigarette smoke that compromises the blood's oxygen-carrying capacity, is 4-6 hours. This half-life indicates the time it takes for the level of carbon monoxide in the blood to decrease by half after cessation of smoking.

Answer 143

Correct Answer: C) Within 12 hours Rationale: Within 12 hours after cessation of smoking, the PaO2 at which hemoglobin is 50% saturated with oxygen (P50) increases, indicating an improvement in the blood's oxygen-carrying capacity. Also, levels of carboxyhemoglobin, which impair oxygen transport, decrease significantly.

Answer 144

Correct Answer: B) 20-30 minutes Rationale: The sympathomimetic effects of nicotine on the heart, which include increased heart rate and blood pressure, last approximately 20-30 minutes after smoking a cigarette

Answer 145

Correct Answer: A) Plasma carboxyhemoglobin levels Rationale: Although short-term abstinence from cigarettes leads to favorable effects on plasma carboxyhemoglobin levels, it has not been proven to decrease postoperative pulmonary complications. Long-term cessation is typically required for a significant reduction in such complications.

Answer 146

Correct Answer: D) 6 weeks or longer Rationale: Improvements in ciliary function and small airway function, as well as decreased sputum production, typically take weeks of abstinence from smoking, with significant benefits often seen at 6 weeks or longer. This time frame allows the respiratory system to heal and regenerate.

Answer 147

Correct Answer: C) 6 weeks Rationale: The return of normal immune function generally requires at least 6 weeks of abstinence from smoking. This restoration is critical for the body's ability to fight infections, particularly following surgery.

Answer 148

Correct Answer: D) Hepatic enzyme activity stimulated by smoking may take 6 weeks or more to return to normal. Rationale: Some components of cigarette smoke can stimulate liver enzymes, which can affect the metabolism of various substances. It may take 6 weeks or longer for this stimulated hepatic enzyme activity to normalize after cessation of smoking.

Answer 149

Correct Answer: C) Irreversible airway dilation, inflammation, and chronic bacterial infection Rationale: Bronchiectasis is characterized by irreversible dilation of the airways, chronic inflammation, and persistent bacterial infection. These changes lead to a cycle of further airway damage and infection.

Answer 150

Correct Answer: B) Patients over 60 with chronic pulmonary diseases such as COPD and asthma, especially women Rationale: Bronchiectasis prevalence is highest in patients older than 60 with chronic pulmonary diseases such as COPD and asthma, and it is more commonly seen in women.

Answer 151

Correct Answer: B) Chronic productive cough with purulent sputum Rationale: Bronchiectasis typically presents with a chronic productive cough with purulent sputum due to the ongoing cycle of infection and inflammation within the dilated bronchial structures.

Answer 152

Correct Answer: B) Poor mucociliary activity and mucous pooling Rationale: Poor mucociliary activity and mucous pooling in bronchiectasis create a cycle of recurrent bacterial infections, which further exacerbates airway inflammation, dilation, and obstruction, leading to difficulty in clearing secretions.

Answer 153

Correct Answer: C) The structural changes in the airways prevent complete clearance of the bacteria. Rationale: In bronchiectasis, the airways are irreversibly dilated and the normal mucociliary clearance is impaired, which allows bacteria to persist and multiply. These structural and functional abnormalities in the airways make it very difficult to eradicate bacterial superinfections completely.

Answer 154

Correct Answer: C) Computed Tomography (CT) Rationale: CT scans are the gold standard for diagnosing bronchiectasis because they can clearly show the characteristic dilated bronchi associated with the condition, as well as other structural changes in the lungs.

Answer 155

Correct Answer: D) Routine surgical intervention Rationale: Surgery is not a routine treatment for bronchiectasis. It is considered only in rare instances where severe symptoms persist or recurrent complications occur. The mainstays of treatment are antibiotics for infection control, chest physiotherapy to aid sputum expectoration, and vaccinations to prevent exacerbations.

Answer 156

Correct Answer: B) Baseline Chest X-Ray (CXR) and Pulmonary Function Test (PFT) Rationale: In patients suspected of having bronchiectasis, baseline CXR and PFT are important initial tests. The CXR can show lung structure and detect some of the changes associated with bronchiectasis, while PFTs evaluate the impact on lung function.

Answer 157

Correct Answer: B) To guide the selection of appropriate antibiotic therapy Rationale: Sputum cultures are critical in the management of bronchiectasis because they identify the specific bacteria causing infection, which allows for targeted antibiotic therapy. This is essential for effective treatment and for preventing the development of antibiotic resistance.

Answer 158

Correct Answer: B) Yearly influenza vaccine Rationale: Yearly influenza vaccination is recommended for patients with bronchiectasis to reduce the risk of exacerbations triggered by viral infections, which can worsen the condition and lead to further complications.

Answer 159

Correct Answer: C) Chloride channels Rationale: CF is an autosomal recessive disorder caused by a mutation in the CFTR gene, affecting the chloride channels in epithelial cells. This leads to abnormal production and clearance of secretions.

Answer 160

Correct Answer: B) Abnormally thick mucus outside of epithelial cells Rationale: The mutation in the CFTR gene in individuals with cystic fibrosis results in the production of abnormally thick mucus outside epithelial cells, contributing to the characteristic clinical symptoms of the disease.

Answer 161

Correct Answer: C) Severe organ damage such as bronchiectasis, COPD, and cirrhosis Rationale: The dysfunction in chloride transport in CF leads to dehydrated viscous secretions and obstruction, which can cause severe organ damage, including bronchiectasis, COPD, sinusitis, diabetes, and cirrhosis, among others.

Answer 162

Correct Answer: C) Fats and fat-soluble vitamins Rationale: Exocrine pancreatic insufficiency is a common issue in CF, leading to the malabsorption of fats and fat-soluble vitamins due to the thick mucus blocking the pancreatic ducts.

Answer 163

Correct Answer: B) Sweat chloride concentration >60 mEq/L Rationale: One of the primary diagnostic criteria for cystic fibrosis includes a sweat chloride concentration greater than 60 mEq/L, which is indicative of the chloride transport dysfunction characteristic of the disease.

Answer 164

Correct Answer: C) High percentage of neutrophils in bronchoalveolar lavage Rationale: Bronchoalveolar lavage in cystic fibrosis patients typically shows a high percentage of neutrophils, which indicates the presence of airway inflammation associated with the disease.

Answer 165

Correct Answer: B) Chronic pansinusitis Rationale: Chronic pansinusitis is almost universal in patients with cystic fibrosis, reflecting the widespread impact of the CFTR mutation on mucus-producing glands, including those in the paranasal sinuses.

Answer 166

Correct Answer: B) COPD Rationale: Chronic obstructive pulmonary disease (COPD) is present in virtually all adult patients with cystic fibrosis as a consequence of the chronic infection and inflammation affecting the lungs over time.

Answer 167

Correct Answer: C) Viscous and elastic abnormalities Rationale: The sputum in cystic fibrosis is characterized by viscous and elastic abnormalities, which hinder its clearance and lead to airway obstruction, a key issue in the pathophysiology of the disease.

Answer 168

Correct Answer: C) Chest physiotherapy with postural drainage Rationale: Chest physiotherapy with postural drainage is the main nonpharmacologic strategy for enhancing secretion clearance in cystic fibrosis, facilitating the removal of thickened mucus from the airways.

Answer 169

Correct Answer: C) An increase of 10% or more in FEV1 Rationale: A beneficial response to inhaled bronchodilators in cystic fibrosis is defined as an increase of 10% or more in FEV1 (Forced Expiratory Volume in 1 second) following administration.

Answer 170

Correct Answer: B) The presence of neutrophils and their degradation products Rationale: The thick viscosity of secretions in cystic fibrosis is caused by the presence of neutrophils and their degradation products, which contribute to the pathophysiology of the disease by obstructing airways.

Answer 171

Correct Answer: C) Cleaves DNA from neutrophils in the sputum Rationale: Recombinant human deoxyribonuclease (DNase) is used to cleave DNA from neutrophils in the sputum, reducing viscosity and facilitating the clearance of secretions.

Answer 172

Correct Answer: C) If sputum cultures show no pathogens Rationale: If sputum cultures from a cystic fibrosis patient show no pathogens, bronchoscopy may be indicated to remove lower airway secretions and further evaluate the cause of persistent symptoms or infections.

Answer 173

Correct Answer: B) Suppress chronic infection Rationale: Many patients with cystic fibrosis are given long-term maintenance antibiotics to suppress chronic bacterial infections, which are a frequent and serious complication of the disease.

Answer 174

Correct Answer: C) Identification of bacteria isolated from sputum cultures Rationale: Antibiotics are given to cystic fibrosis patients based on the identification of bacteria isolated from sputum cultures to ensure targeted and effective treatment.

Answer 175

Correct Answer: B) To aid in blood clotting processes Rationale: Vitamin K may be necessary if hepatic function is impaired in CF patients because the liver's ability to synthesize clotting factors, which are dependent on vitamin K, can be compromised, leading to an increased risk of bleeding.

Answer 176

Correct Answer: B) Avoidance of anticholinergic drugs Rationale: In CF anesthesia, it's important to avoid anticholinergic drugs (Typical symptoms include dry mouth, constipation, urinary retention, bowel obstruction, dilated pupils, blurred vision, increased heart rate, and decreased sweating) which can thicken secretions; instead, strategies such as humidification of inspired gases and hydration are utilized to maintain less-viscous secretions.

Answer 177

Correct Answer: C) To remove accumulated thick secretions Rationale: Frequent tracheal suctioning may be required to manage the thick, tenacious secretions typical in CF patients, helping to prevent postoperative atelectasis and pneumonia.

Answer 178

Correct Answer: B) Chronic sinusitis, bronchiectasis, and situs inversus Rationale: Kartagener syndrome is defined by the presence of a clinical triad that includes chronic sinusitis, bronchiectasis, and situs inversus. This syndrome is a subset of primary ciliary dyskinesia, where there is congenital impairment of ciliary function.

Answer 179

Correct Answer: B) 50% Rationale: Approximately half of the patients with primary ciliary dyskinesia, which results in nonfunctioning cilia, present with situs inversus due to the role cilia play in determining organ position during embryogenesis.

Answer 180

Correct Answer: B) Congenital heart disease Rationale: Isolated dextrocardia, where the heart is located on the right side of the thorax, is most frequently associated with congenital heart disease rather than as an isolated finding or associated with situs inversus alone.

Answer 181

Correct Answer: B) Regional anesthesia (RA) Rationale: Regional anesthesia is preferable to general anesthesia in patients with Primary Ciliary Dyskinesia as it can help decrease the risk of postoperative pulmonary complications, which these patients are at increased risk for due to their underlying pulmonary pathology.

Answer 182

Correct Answer: B) To adapt to the mirrored position of the heart Rationale: In the presence of dextrocardia, EKG lead placement is reversed to obtain an accurate interpretation that corresponds to the heart's mirrored position in the thorax, ensuring that the EKG reflects the appropriate cardiac activity.

Answer 183

Correct Answer: D) It provides a direct route to the superior vena cava (SVC) in the context of vascular inversion. Rationale: Normally, the right internal jugular vein is preferred for CVC because it has a more direct route to the SVC. However, in patients with inversion of the great vessels, the anatomical pathways are mirrored, making the left IJ vein the more direct route to the SVC.

Answer 184

Correct Answer: D) Uterine displacement to the right Rationale: Normally, left uterine displacement (LUD) is implemented during surgery to avoid aortocaval compression by the gravid uterus, which can compromise venous return and cardiac output. However, in certain conditions, including anatomical variations or when a vena cava syndrome is present or anticipated, displacement to the right may be considered to optimize hemodynamics.

Answer 185

Correct Answer: C) An obstructive pattern with a reduced FEV1/FVC ratio that is unresponsive to bronchodilators. Rationale: Bronchiolitis Obliterans is characterized by an obstructive pattern on PFTs, signified by a reduced FEV1 and FEV1/FVC ratio. The key aspect of this disease is the lack of responsiveness to bronchodilators, which differentiates it from conditions like asthma, where a significant reversibility with bronchodilators is typically seen.

Answer 186

Correct Answer: C) Air trapping and bronchiectasis in severe cases. Rationale: High-resolution CT scans in Bronchiolitis Obliterans commonly reveal air trapping due to the obstructed airways, and bronchiectasis may be seen as the disease progresses. These findings are consistent with the chronic and obstructive nature of the disease, helping to distinguish it from other respiratory conditions that may present differently on imaging.

Answer 187

Correct Answer: B) Stem cell transplant. Rationale: Stem cell transplants are listed as a risk factor for Bronchiolitis Obliterans, often related to an immune-mediated response. Environmental exposures and post-transplant immunological reactions are known to play roles in the development of this disease, while the other options are not commonly associated with increased risk for Bronchiolitis Obliterans.

Answer 188

Correct Answer: B) 20-30% Rationale: The slide states that 20-30% of lung cancer patients can be affected by airflow obstruction, which may be due to the direct effects of the tumor on the airways or secondary complications such as granulation tissue or cartilage destruction.

Answer 189

Correct Answer: B) Tracheal stenosis Rationale: Prolonged intubation with an endotracheal tube (ETT) or a tracheostomy tube can result in tracheal stenosis. This is due to tracheal mucosal ischemia that may progress to cartilaginous ring destruction and scar formation, leading to narrowing of the tracheal lumen.

Answer 190

Correct Answer: C) By using high-volume, low-pressure cuffs on endotracheal tubes Rationale: High-volume, low-pressure cuffs on endotracheal tubes are designed to distribute pressure more evenly along the tracheal wall. This minimizes the risk of ischemic damage to the tracheal mucosa, which can lead to stenosis. While minimizing the duration of intubation and systemic corticosteroids may be beneficial in certain scenarios, they are not mentioned in the slide as specific measures to prevent tracheal stenosis. Regular tracheostomies are a treatment for prolonged intubation, not a preventive measure for stenosis.

Answer 191

Correct Answer: C) Stridor Rationale: Stridor, a high-pitched breathing sound, is usually audible in cases of tracheal stenosis.

Answer 192

Correct Answer: B) Flattened inspiratory and expiratory curves Rationale: Flattened inspiratory and expiratory curves on flow-volume loops are indicative of fixed airway obstruction, such as that seen in tracheal stenosis. (central airways are the mainstem bronchus or the trachea)

Answer 193

Correct Answer: C) Several weeks after extubation Rationale: Symptoms of tracheal stenosis may not present immediately but can develop several weeks following extubation. Accessory muscles are utilized throughout all phases of the breathing cycle

Answer 194

Correct Answer: C) Computed Tomography (CT) scan Rationale: A CT scan can provide detailed images of the trachea, making it a valuable tool for illustrating the extent of tracheal narrowing. Sx of dyspnea is prominent even at rest

Answer 195

Correct Answer: C) Surgical resection and reconstruction with primary re-anastomosis Rationale: Surgical resection with primary re-anastomosis is often the most definitive and successful treatment for tracheal stenosis.

Answer 196

Correct Answer: B) To decrease the density of the gas mixture and improve flow Rationale: Helium is less dense than air, so its addition to the inspired gases can decrease the overall density of the gas mixture, improving flow through narrowed areas like tracheal stenosis.

Answer 197

Correct Answer: C) Translaryngeal intubation Rationale: Translaryngeal intubation provides a secure airway that does not interfere with the surgical field during tracheal resection and reconstruction.

Answer 198

Correct Answer: B) They ensure maximal fractional inspired oxygen (FiO2) Rationale: Volatile anesthetics can be precisely controlled and provide a high FiO2, which is crucial for patients with tracheal stenosis who may have compromised oxygenation.

Answer 199

Correct Answer: C) To allow connection to the anesthesia circuit and maintain ventilation Rationale: The use of a sterile cuffed ETT after surgical exposure of the distal trachea is critical for maintaining ventilation by allowing the tube to be connected securely to the anesthesia circuit.

Answer 200

Correct Answer: C) Reducing secretions and limiting airway manipulation Rationale: For a patient with a recent URI, it is important to minimize airway manipulation to avoid triggering bronchospasm or laryngospasm due to a potentially hyperresponsive airway. Reducing secretions helps maintain airway patency.

Answer 201

Correct Answer: B) To depress airway reflexes and avoid bronchoconstriction Rationale: Asthmatic patients have hyperresponsive airways. The goal during induction and maintenance of anesthesia is to depress airway reflexes to avoid bronchoconstriction, which can lead to serious complications.

Answer 202

Correct Answer: C) Aggressive antibiotic therapy Rationale: While antibiotics are used during acute exacerbations of COPD, they are not a primary treatment goal for managing the disease overall. Smoking cessation and long-term oxygen therapy are key interventions for slowing disease progression. Managing exacerbations with appropriate drug therapy is also essential.

Answer 203

Correct Answer: C) To decrease exacerbations Rationale: COPD is a chronic and progressive disease with no cure. The goal of drug therapy, which includes inhaled β-agonists, inhaled corticosteroids, and anticholinergic drugs, is to manage symptoms and decrease the frequency and severity of exacerbations. In COPD, smoking cessation and long-term 02 therapy are the only two interventions that may slow progression

Answer 204

Correct Answer: B) RA decreases the risk of bronchospasm and barotrauma. Rationale: RA is preferred in patients with COPD because it is associated with a lower incidence of bronchospasm, barotrauma, and the need for positive pressure ventilation compared to GA.

Answer 205

Correct Answer: B) Slow respiratory rates to allow sufficient time for exhalation. Rationale: In COPD patients under GA, slow respiratory rates are crucial to allow adequate time for exhalation. This minimizes the risk of air trapping and auto-PEEP (positive end-expiratory pressure).

Answer 206

Correct Answer: A) Restoring lung volumes, particularly FRC. Rationale: Postoperative pulmonary complications can be minimized by prophylactic measures aimed at restoring lung volumes, especially functional residual capacity (FRC), and facilitating effective coughing to clear secretions.

Answer 207

Correct Answer: C) By deepening the anesthetic, administering bronchodilators, and suctioning secretions. Rationale: Intraoperative bronchospasm is treated by deepening the anesthetic to decrease airway reactivity, administering bronchodilators to reverse bronchoconstriction, and suctioning secretions to clear the airway.

Health Ass 4: Obstructive alternative questions Flashcards

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