Quiz 4

Question 1

What is COPD?

Answer 1

preventable/treatable PROGRESSIVE development of airflow limitation that is NOT FULLY REVERSIBLE; usually an exaggerated INFLAMMATORY reaction

Question 2

What is the principal risk factor for the development of COPD?

Answer 2

smoking (>70 pack years)

Question 3

What is another risk factor for COPD besides smoking?

Answer 3

alpha 1 antitrypsin deficiency

Question 4

Is CO2 elevation a concern early on in COPD?

Answer 4

usually no- CO2 is 20x more soluble than O2 and elevation can be offset by increase in MV

Question 5

What are symptoms of COPD?

Answer 5

cough, sputum production, wheezing, SOB, progressive exercise intolerance

Question 6

What is affected first in COPD, O2 or CO2?

Answer 6

O2

Question 7

What are some changes in PFTs that you would see in COPD?

Answer 7

decrease in FEV1/FVC, decrease in FEF25-75%, increased RV and normal to increased FRC and TLC

Question 8

What CXR findings would you see with COPD?

Answer 8

flattened diaphragm, hyperinflation

Question 9

What are some differences between chronic bronchitis and emphysema?

Answer 9

chronic bronchitis- inflammation/mucous, blue bloater, CO2 increased, increased Hct, cor pulmonale

emphysema- loss of recoil, severe dyspnea, pink puffer, normal/decreased CO2, decreased diffusion

Question 10

What are the stages of GOLD spirometry classification of COPD?

Answer 10

I- mild, FEV1 >80% of predicted
II- mod, FEV1 50-80% predicted
III- severe, FEV1 30-50% predicted
IV- very severe, <30% or <50% with chronic resp failure

Question 11

What are the mainstays of treatment for COPD?

Answer 11

smoking cessation, O2 supplementation if PaO2 <55, Hct >55%, or evidence of cor pulmonale

goal PaO2 60-80 mmHg

Question 12

What is drug therapy for COPD?

Answer 12

bronchodilators, diuretics, annual vaccinations

Question 13

What are bullae?

Answer 13

hyper enlarged air spaces distal to terminal bronchioles- complication of emphysema

Question 14

What are blebs and what should you avoid?

Answer 14

collections of air bubbles within pleura- usually related to mechanical ventilation; nitrous

Question 15

What can occur in chronic bronchitis as a result of increased catecholamine levels?

Answer 15

increased cardiac output

Question 16

What are some pre-op findings in COPD that would increase risk of post-op respiratory failure?

Answer 16

FEV1:FVC of <0.5, PaCO2 >50, acute bacterial infection, no smoking cessation, poor exercise tolerance

Question 17

What are some immediate effects of smoking cessation?

Answer 17

P50 increases, carboxyhemoglobin decreases, sympathomimetic effects of nicotine last 20-30 minutes

Question 18

What are some intermediate effects of smoking cessation?

Answer 18

improved ciliary function, decreased sputum production, return of normal immune function and hepatic enzyme secretion

Question 19

When it comes to regional anesthesia, what should you avoid in someone with respiratory complications?

Answer 19

blocks above T6 and interscalene blocks- can worsen respiratory dysfunction

Question 20

What are some anesthesia considerations for patients with obstructive disease?

Answer 20

volatile anesthetics act as bronchodilators; use smaller concentrations due to increased time to blow it off, use humidification, expect longer induction/emergence, use large TV and slow rate, cautious with narcotics, use LMA/spont breathing when possible

Question 21

What are some signs that the patient is air trapping?

Answer 21

increased alpha angle on capnography, expiratory flow does not reach baseline before next breath, PEEP measurement

Question 22

What is asthma?

Answer 22

CHRONIC INFLAMMATORY disorder of airways, airflow obstruction generally reversible either spontaneously or with treatment; bronchial hyperreactivity

Question 23

What are some important H&P components in patients with asthma?

Answer 23

previous intubations, admission to ICU, 2+ hospitalizations in last year, co-existing disease

Question 24

What are signs and symptoms of asthma?

Answer 24

wheezing, cough, dyspnea, chest discomfort or tightness, air hunger, eosinophilia

Question 25

What are some provoking stimuli for asthma?

Answer 25

allergens, drugs (ASA, B antagonists, NSAIDs), resp infections, exercise

Question 26

What are some theories for underlying causes of asthma?

Answer 26

deficiency of acquired immunity, genetics, abnormal autonomic regulation, exposure to respiratory system irritants