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Obstructive Lung Disease Flashcards

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1
Q

the age 25-44 experience the “common cold” at what rate per year

A

19%

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2
Q

the age 45-65 experience the “common cold” at what rate per year

A

16%

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3
Q

T/F a fraction of scheduled surgery patients will have an active URI

A

true

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4
Q

what accounts for 95% of all URIs

A

infectious nasopharyngitis

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5
Q

associated viral pathogens in the URI

A

rhinovirus
coronavirus
influenza
parainfluenza
RSV

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6
Q

noninfectious nasopharygitis can be of what 2 origins

A

allergic or vasomotor

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7
Q

T/F viral culture and lab tests are sensitve, tho time consuming

A

false, viral culture and lab tests lack sensitivity

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8
Q

children with URIs have a higher risk of what perioperative adverse events

A

laryngospasm
coughing
breath holding
transient hypoxemia

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9
Q

a patient has had a URI for _____ and is ____ and improving can be safely managed without postponing surgery

A

weeks; stable

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10
Q

if surgery is cancelled due to active URI, it should be rescheduled within

A

6 weeks due to airway hyperreactivity

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11
Q

the COLDS scoring system takes into account what 5 things

A

current symptoms
onset of symptoms
presence of lung disease
airway device present
type of surgery

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12
Q

anesthetic management of patients with URI includes

A

adequate hydration, reducing secretions, and limiting airway manipulation

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13
Q

what can be done to reduce upper airway sensitivity

A

inhaleed or topical local anesthetics on the vocal cords

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14
Q

as far as airway/ventilation management what can be done to reduce risk of laryngospasm

A

use of LMA over ETT

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15
Q

when there are no contraindications; what can be done for a smoother emergence

A

deep extubation

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16
Q

adverse respiratory events in patients with URI

A

bronchospasm
laryngospasm
airway obstruction
postintubation croup
desaturation
atelectasis

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17
Q

intraoperative and postoperative hypoxemia are common and treated with

A

supplemental O2

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18
Q

what is astham

A

chronic inflammation of the mucosa of the lower airways

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19
Q

with asthma activation of the inflammatory cascade leads to

A

infilitration of airway mucosa with eosinophils, neutrophils, mast cells, T cells, B cells, and leukotrienes

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20
Q

the inflammatory cascade involving eosinophils, neutrophils, mast cells, T cells, B cells and leurkotrienes causes what

A

airway edema; especially in the bronchi

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21
Q

what kind of airway remodeling occurs with asthma

A

thickening of the basement membrane and smooth muscle mass

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22
Q

the main inflammatory mediatiors implicated in asthma include

A

histamine
prostaglandin D2
leukotrienes

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23
Q

what can provoke asthma

A

allergens
ASA, NSAIDs, sulfiting drugs
infections
exercise
emotional stress

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24
Q

T/F excersie induce asthma occurs after the exertion

A

true

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25
asthma is an episodic disease with _________ _______ and ______ _______
acute exacerbations and asymptomatic periods
26
symptoms of asthma include
expiratory wheeze, productive/nonproductive cough dyspea chest tightness eosinophilia
27
what is status asthmaticus
dangerous, life threathening bronchospasm that persists despite treatment
28
when the history is obtained from an asthma patients- what is ur focus of assessment
intubation for asthma ICU admission for asthma 2+ hospitalizations for astham in the past year and presence of coexisting disease
29
diagnosis of asthma depends on
clincal history, symotoms, objective measurements of airway obstruction
30
astham is diagnosed when
pt reports wheezing, chest tightness, or SOB, and demonstrates airflow obstruction on PFT (that is at least partially reversible by bronchodilators
31
FEV1 normal values
80-120%
32
lung tests used with asthma
FEV1 FVC FEV1:FVC FEF 25-75 Diffusing Capaity (DCLO)
33
FVC normal values male/female
male - 4.8L female - 3.7L
34
normal FEV1/FVC ratio in adults
75-90%
35
maximum ventilatory ventilation is a test that examines
the maximum amount of air that can inhaled and exhaled within 1 min **for patient comfort it is measured over 15 sec time period**
36
what PFTs are a direct measure of the severity of the expiratory obstruction
FEV1 FEF midexpiratory phase flow
37
what is the FEV1 of a symptomatic asthmatic patient
FEV1 <35%
38
during moderate to severe astham attacks what effects are seen on TLC and FRC
FRC increases but TLC is unchanged
39
with expriatory obstruction and relief f obstruction after administration of bronchodilator suggests
asthma
40
t/f abnormal PFTs may persist for several days after an attack despite absence of symptoms
true | since asthma is episodic, diagnosis can be suspected with normal PFTs
41
mild asthma attack is accompanied by what ABG findings`
normal PaO2 and PaCO2
42
during an asthma attack tachypnea and hyperventilation is caused by
neural reflexes of the lung **not hypoxemia**
43
what ABG findings might you see in sytmptomatic asthma patient
hypocarbia and respiratory alkalosis
44
as the severity of expiratory obstruction increases, the associated VQ mismatching results in a PaO2 of
less than 60 mmHg
45
when is the PaCO2 likely to increase in an asthmatic patient
when FEV1<25% of predicted value
46
what can cotnribute to the hypercarbia during an asthamtic attack
fatigue of skeletal muscles
47
EKG findings of severe asthma patietns
hyperinflation and hilar vascular congestion due to mucous plugging and pulmonary HTN
48
what can EKG reveal during an asthma attack
R heart strain or ventricular irritability
49
differiental diagnosis of asthma includes
viral tracheobronchitis sarcoidosis rhematoid arthritis with brnchotis extrinsic/intrinsic AW compression vocal cord dysfunction tracheal stenosis chronic bronchitis, COPD, and foriegn body aspiration
50
treatment for asthma aims to
control symptoms and reduce exacerbation
51
1st line treatment for mild asthmatic patients
short acting inhaled B2 agonist | recommended in those with <2 exacerbations a month
52
what can be added to asthmatic therapy to reduce exacerbations adn decrease risk of hospitalization
inhaled corticosteroid
53
if asthma symptoms remain uncontrolled what is added to therapy
daily B2 agonist
54
other therapy options for asthma
inhaled muscarinic atagonists, leukotriene modifiers, and mast cell stabilizers
55
when are systemic corticosteroids used for asthmatic therapy
severe asthma uncontrolled with inhaled medications
56
what therapy can be used in asthma treatment to decrease long term use of medications and improve quality of life
SQ immunotherapy
57
what is bronchial thermoplasty and why is it used in asthma therpay
bronchscopy delivers radiofrequency ablation of smooth muscles to all lung fields except the right middle lobe *loss of airway smooth muscle is thought to reduce bronchoconstriction*
58
with bronchial thermplasty what lobe of the lung is not targeted
right middle lobe
59
how many sessions of bronchial thermoplasty is recommended
3 sessions **risk for airway fire**
60
with bronchial thermoplasty when the FEV1 improves how much of normal - do patients have minimal or no symoptoms
about 50%
61
acute severe asthma (status asthmaticus)
bronchocspasm that doesnt resolve despite usual therapy | considered life threatening
62
treatment for acute severe asthma
high dose, short acting B2 agonist and systemic corticosteroids
63
inhaled b2 agonist can be used in treatment of acute severe asthma every
15-20 min for several doses without hemodynamic effects | although pts may experience unpleasant sensations due to adrenegic stim
64
2 most commonly administered corticosteroids for acute severe asthma
methyprednisone hydrocortisone
65
with acute severe asthma, when is supplemental O2 given
to maintain saturations > 90%
66
other drug therapies for acute severe asthma
magneisum, oral leukotriene inhibitors
67
when is tracheal intubation warranted for acute severe asthma
PaCO > 50 mmhg
68
MV parameters in acute severe asthma
high gas flows permit short inspiriation timesand longer expiration expiration time must be prolonged to avoid air trapping "auto-peep" permissive hypercarbia
69
what is the likelihood of bronchospasm in asthmatics undergoing GA
0.2-4.2%
70
risk of bronchoscopasm is correlated with the type of surgery - what surgeries increase the risk
upper abdominal and oncologic surgery
71
GA mechanisms that increase airway resistance
depression of cough reflex impairment of mucocilliary funciton, reduction of palatopharyngeal muscle tone depression of diaphragmatic function increaed fluid in the airway walll
72
other factors increasing airway resistance in asthamtic patietns undergoing GA
airway stim (intubation) PNS activation and or release of neurotransmiters (Substance P and neurokinins)
73
preop assessment of asthmatic patient includes
notes of symptom control frequency of exacerbations need for hospitalization or intubation previous anesthesia tolerance
74
what physcial assessment might you note of your asthmatic patient preop
use of accessory muscles wheezing/creptitis
75
t/f eosinophil count mirrors the degree of inflammation
true
76
what PFTs might you want before heading back to surgery with an asthma patient
FEV1 before and after bronchodilator
77
what PFT findings prdict the risk of periop respiratory complications
FEV1 or FVC < 70% predicted FEV1:FVC ratio < 65% predicted
78
what can improve reversible components of asthma
chest physiotherapy, antibiotics, and bronchodilators
79
how long do you continue preop anti-inflammatories and bronchodilators
until induction ## Footnote q
80
if patients are on systemic corticosteroids for asthma within the past 6 months, what is indicated
stress dose hydrocortisone or methylprednisone
81
ideally patietns should be free of ______ and have a PEFR of > _____ % of predicted or their personal best before surgery
free of wheezing PEFR > 80%
82
COPD is a disease of
chronic airflow obstruction
83
symptoms of COPD include
emphysema - lung parynchema destruction, chronic bronchitis, productive cough and small airway disease
84
COPD prevalence and rank in leading cause of death
10% 3rd leading cause of death
85
risk factors for COPD
cigarette smoke, occupational exposure to dust and chemicals, absetos, gold mining, biomass fuel, air pollution. genetic factors, age, female, poor lung development during gestation, low birth weight

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