Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Advance Anesthesia II > Pulmonary Pathophysiology Part II > Flashcards

Pulmonary Pathophysiology Part II Flashcards

Exam 3

1
Q

Restrictive lung disease?

A

Any condition that interferes with normal lung expansion during inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Restrictive lung disease is characterized by a:

A
  • TLC below 5th percentile
  • Decrease lung volume and compliance
  • Preservation of expiratory flow rates
  • Acute
  • Chronic intrinsic
  • Chronic Extrinsic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Chronic Extrinsic(extrapulmonary) involves:

A
  • Pleura
  • Chest wall
  • Diaphragm
  • Neuromuscular function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pulmonary edema:

A
  • Edema due to leakage of intravascular fluid into the interstitium of the lungs and into the alveoli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Acute pulmonary edema is caused by:

A
  • Increase capillary pressure (hydrostatic or cardiogenic)
  • Increase capillary permiability
  • Presence of bronchograms on the Chest x-ray
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cardiogenic pulmonary edema is caused by:

A
  • Extreme dyspnea
  • Tachypnea
  • SNS activation(HTN, tachycardia, diaphoresis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cardiogenic pulmonary edema is more pronouced in patients with:

A

Increased-permeability pulmonary edema (ARDs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

C-xray may not show evidence of aspiration pneumonitis for:

A

6-12 hrs after the event

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When Aspiration symptoms appear are more likely to be in:

A

Right lower lobe

If patient aspirated in supine position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

High Altitude edema is pressume to be:

A
  • Hypoxic pulmonary vasoconstriction
  • Increase pulmonary vascular pressures (PVR)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pulmonary Edema: Anesthesia Management

A
  • Elective surgery should be delay
  • Low tidal volumes 6 ml/kg
  • RR of 14-18 bpm
  • Inspiratory plateua pressures < 30 mmHg H2O
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pharmacologic agents for Pulmonary Edema

A
  • Vasodilators
  • Inotropes
  • Steroids
  • Diuretics
  • Morphine (cardiogenic pulmonary edema)
  • Nitroprusside (effective for preload/afterload reducer)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Aspiration Pneumonitis Aspirates are categorized as:

A
  • Contaminated
  • Acidic
  • Alkaline
  • Particulate
  • Norpaticulate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pneumonitis?

A
  • Chemical injury
  • Serious complication of GETA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pneumonitis from periop aspiration is known as:

A

Mendelson’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Aspiration pneumonitis is a result of three components:

A
  1. Gastric content into the pharyxn
  2. Contents enter the lungs
  3. Lead to injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Most common depression of reflexes occur during:

A
  • Anesthesia induction and Emergence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Three aspiration syndromes:

A
  1. Chemical pneumonitis (mendelson’s syndrome)
  2. Mechanical obstruction
  3. Bacterial infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Hallmark of aspiration:

A

Arterial hypoxemia (first sign)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Other sings of aspiration include:

A
  • Tachypnea
  • Dyspnea
  • Tachycardia
  • Hypertension
  • Cyanosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Aspiration Chest x-ray will show:

A
  • Infiltrates in peripheral and dependent region(most common)
  • Pulmonary edema (most common)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Anesthesia technique in aspiration:

A

Regional anesthesia > GETA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

It is still the standard of care for Aspiration:

A

Cricoid pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Mainstay prophylaxis againts aspiration:

A

Keep Patient NPO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Minumun Fasting hours required for Clear liquids?
2 hrs
26
Minimal fasting hours required for Breast milk?
4 hours
27
Minimal fasting hour required for Light meal, animal milk, infant formula?
6 hours
28
Minimal hours required for fatty meal?
8 hours
29
Drugs for Prophylaxis for Aspiration risk:
1. GI stimulants (Reglan) 2. H2 Antagonist (Cemitidine/Pecid) 3. PPIs (Omeprazole/Lansoprasole) 4. Antiacids ( Na+ citrate, Na+ Bicarb, Mag+ trisilicate) 5. Antiemetics ( Droperidol/Ondansetron) 6. Antichollinergics ( Atropine, Robinol, Scopolamine)
30
Actions if vomiting and aspiration occurs during induction:
* Tilt patient head downward or to the side * Rapid suction of mouth and pharyxn * Intubate
31
Bronchoscopy is reserved for those who aspirated with
Solid material
32
If severe aspiration:
Surgery may be postpone
33
Patient may be discharge s/p aspiration if no significant symptoms occur:
within 2 hours of the incidence
34
Aspiration discharge criteria involves
* PT without symptoms (new cough, wheeze) * No decrease in SpO2 > 10% of ProOp levels in RA * No A-a gradient > 300 mmHg * Negative chest x-ray
35
ARDs Hallmark:
Noncardiogenic pulmonary edema
36
Acute lung injury PaO2/FiO2 ratio?
< 300 mmHg (regardless of PEEP level)
37
ARDs PaO2/FiO2 ratio?
< 200 mmHg regardless PEEP level
38
Most Common event and Risk associated with ARDs:
* Sepsis * Bacterial pneumonia * Trauma * Aspiration pneumonitis
39
Prostaglandin metabolites mediates:
1. Pulmonary vasoconstriction 2. Alter vascular reactivity 3. Airway constriction
40
Altered vascular reactivity decreases:
Hypoxic pulmonary vasoconstriction
41
**Microembolus** formation is a common manifestion of:
ARDs
42
ARDs Treament goals:
* Maintain oxygenation (main goal) * Reduce further lung damage ( main goal) * Preserve organ perfusion (most important)
43
ARDs has no definitive Tx. Some approaches include:
* Decrease inflammatory reaction * Improve oxygenation * Corticosteroids * Inhaled nitric oxide * Exogenous surfactant * ECMO
44
ARDs treatment is
Supportive Correction of Hypoxemia
45
Pressure Controlled Ventilation Clinical conditions:
* Severe asthma * COPD * Salicylate toxicity
46
Volume-Controlled Ventilation Clinical Conditions:
* Acute lung injury (ARDs) * Obesity * Severe burns
47
ARDs anesthesia management:
* Avoid Barotrauma and Volutrauma * Prevent Atelectasis & Airway closure
48
ARDs Anesthesia management focus on
Supporting RV performance with prone positioning
49
Prone Positioning Benefits:
* Improves airway pressure * Gas exchange * Decrease indicators of Cor Pulmonale
50
Bleomycin?
* Most common of pulmonary injury * Pulmonary fibrosis incidence of ~ 20% * 1% mortality rate
51
Flail chest Hallmark
Paradoxical movement of chest wall at side of injury
52
Flail chest result from:
* Chest trauma * Multiple rib fractures
53
Flail chest during inspiration the chest wall is
Draw inward
54
During Expiration Flail chest the chest wall is
Draw outward
55
Flail chest Mechanical Ventilation:
56
Select the image during Flail chest Inspiration and Expiration
57
Pneumothorax Categories:
1. Simple Pneumothorax 2. Communicating pneumothorax 3. Tension pneumothorax
58
Severity classification of simple pneumothorax
* Small = 15% or less * Moderate = 15% - 60% * Large = Collapse > 60%
59
Simple Pneumothorax Tx
* Determined by size and cause of injury * Catheter aspiration * Thoracotomy * Closed observation * **Avoid Nitrous Oxide**
60
Affected lung on Communicating Pneumothorax collapses on
Inspiration
61
Communicating Pneumothorax Management:
* Cover with occlusive dressing * Allows egress of air from inside the thorax to avoid tension pneumothorax * Suplemental O2 * Tube tracheostomy * Intibation: Mech Ventilation
62
If the Tension Pneumothorax pressure is too high:
Mediastinum shift to opposite Hemithorax
63
Hallmark signs of Tension pneumothorax:
* Hypotension * Hypoxemia * Tachycardia * Increase CVP * Increase airway pressure
64
Tension Pneumothorax management:
* Chest decompression with 14g needle on 2nd ICS anteriorly * Chest decompression with 14g needle on 4th or 5th ICS laterally
65
Angiocatheter converts Tension Pneumothorax to:
Simple pneumothorax
66
Hemothorax?
Accumulation of blood in the pleural cavity
67
Thoracostomy if the inital bleeding of Hemothorax is :
> 20 mL/kg/hr
68
Thoracostomy is indicated if:
* If bleed subside, but rate remains > 7 mL/kg/hr * Chest x-ray worsen * Refractory hypotension * Failed blood transfusion and decompression
69
Atelectasis Prevents:
Respiratory exchange of CO2 and O2
70
Atelectasis is common with
General Anesthesia
71
Atelectasis develops:
* Within first few min of induction regardless the vent mode * Persist hours to days post anesthesia
72
Atelectasis Common causes:
* **Impaired surfactant** * Compression of lung tissue * Absence of diaphragmatic-induced negative pressure * Oxygen absorption for Nitrogen-free alveoli
73
Atelectasis Treatment
* **Small tidal volume 6 to 10 mL/kg** * **PEEP** * Vital capacity maneuvers * Open lung ventilation
74
Atelectasis Standard Postop measures:
1. **CPAP (offers greatest increase FRC)** 2. Incentive spirometry 3. Deep breathing 4. Intermittent positive-pressure breathing
75
Pleural Effusion?
Abnormal accumulation of fluid in the pleural space
76
Pleural effusion possible causese:
* Blockage of lymphatic drainage from pleural cavity * Cardiac failure * Redution in plasma colloid osmotic pressure * Infection or inflammatory process
77
Pleural effusion treatment
* Tube thoracostomy * Thoracentesis * Pleurodesis
78
Kyphoscoliosis Clinical features:
* Angles measure by Cobb technique * Decrease pulmonary function at curvatures > 60 deg * **Pulmonary symptoms with curvature > 70 deg** * Impair gas exchange with curvature > 100 deg
79
Scoliosis is associated with:
Malignant Hyperthermia
80
Kyphosis is deformity marked by:
Accentuated posterior curvature of the spine
81
Scoliosis is:
A lateral curvature of the spine
82
Kyphoscoliosis surgical treatment:
Anterior or posterior spinal fusion and instrumentation ( Harrington rod insertion)

Advance Anesthesia II (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions