Resp 2

Question 1

Pulmonary edema from tube will be what color

Answer 1

pink man

Question 2

Pulmonary edema ( acute intrinsic restrictive lung diseases) causes

Answer 2

aspiration, ACDS neurogenic, problems, opioid overdose, high alt, re expansion of collapsed lung, upper airway obstruction (neg pressure), CHF

Question 3

Pulmonary edema pattern on CT

Answer 3

batwing or butterfly

Question 4

Two types of pulmonary edema

Answer 4

cardiogenic PE & increased capillary permeability PE

Question 5

cardiogenic pulmonary edema characteristics

Answer 5

will be assumed first before in cap perm. Xtreme dyspnea, tachy hyper, diaphoresis

Question 6

increased capillary permeability pulmonary edema

Answer 6

same as cardio but higher protein

Question 7

Aspiration signs

Answer 7

tachy, broncho, acute pul hyper. chest Xray ray may be 6-12 h after

Question 8

Which lobe most often aspiration in supine?

Answer 8

Right lower lobe

Question 9

Treatment for aspiration

Answer 9

02, PEEP, bronchodilation, corticosteroid treatment is +- with controversy

Question 10

Neuro problems

Answer 10

sympathetic overload from injured ICP –> vasocon, blood vol shift, increases pulmonary capillary pressure

Question 11

Opioid induced pulmonary edema

Answer 11

high perm pulm edema may result following administration of opioids. Evidence says do not give naloxone

Question 12

Opioid induced pulmonary edema trtment

Answer 12

Support, tracheal intubation, mech vent. Evidence says do not give naloxone

Question 13

High altitude Pul edema cause

Answer 13

Hypoxic pulmonary vasoconstriction= Increased pulmonary vascular pressures. Nitric oxide when oxygen? (nitric not okay for adult just kids)

Question 14

re expansion of collapsed lung trick

Answer 14

usually 24h (not a lung or heart case for a couple hours). when you get chest tube in do not expand in all one breath. slowly increase tidal volumes.

Question 15

Upper airway obstruction ( neg pressure pul edema)

Answer 15

OSA patients, any airway stuff

Question 16

Buried kid story

Answer 16

increased in transcapillary pressure gradient

Question 17

Negative pressure pul edema (onset, symptoms, trtment)

Answer 17

2-3 hours post obstruction relief, pink froth, tachy, cough failure sat 95, trtmt= mt of airway supp oxygen, mech vent.

Question 18

Management of PE anestetically

Answer 18

Delay elective, optimize cardiac & respiratory, mech vent & PEEP if hypoxemia is present (02 is less than 90)

Question 19

Intraop management

Answer 19

double RR half tv, & MORE

Question 20

Interstitial lung disease

Answer 20

chronic inflam of interstitial tissue, progressive pul fibrosis ( VC & FRC down) less than 70 ml/kg VC, less 15 means severe

Question 21

Pul HTN

Answer 21

mean PAP >25mmHg, with PAWP

Question 22

Fibrotic lung disease CXR

Answer 22

honeycomb

Question 23

Worsen Pul HTN by:

Answer 23

hypoxia, hypercapnia, acidosis, hypothermia, Extreme catecholamines surges should be avoided

Question 24

Sarcoidosis

Answer 24

systemic granulomatous disorder (granuloma = local collection of macrophages)
Symptoms: dyspnea cough, hypercalcemia
mediastinoscopy

Question 25

Hypersensitivity pneumonitis

Answer 25

Diffuse interstitial granulomatous rxns ( fungi, black mold etc) 4-6 hours cough after

Question 26

Alveolar proteinosis

Answer 26

Hella protein in lungs. Common causes: chemo patients, AIDS, mineral dusts. dan says he would do DLT with lung lavage in one lung at time

Question 27

Lymphangioleiomyomatosis (LAM)

Answer 27

excessive smooth muscles in airway , lympthatics, blood vessels. reproductive age females.rest&obst DECREASE IN FEV1 FEV ratio.

Question 28

Lymphangioleiomyomatosis (LAM) fatal within _ years

Answer 28

10

Question 29

Autoimmune diseases causing PE

Answer 29

rheumatoid arthritis & esinophilic granuloma

Question 30

Bleomycin & nitrofurantoin S/e

Answer 30

PE, o2 toxcitiy. MUST DECREASE OXYGEN AS LOW AS POSSIBLE! (for spo2 of 88-92%)

Question 31

What patients may have bleomycin

Answer 31

hodgkins lymphoma.

Question 32

Chronic extrinsic restrictive lung disease

Answer 32

disorders on the thoracic cage which interfere with lung expansion

Question 33

Chronic extrinsic restrictive lung disease causes

Answer 33

``` Obesity Deformities of the costovertebral skeletal structures Sternum deformities Flail chest Neuromus disorders ```

Question 34

Why is Obesity is a Chronic extrinsic restrictive lung disease?

Answer 34

Inc. restricive load on cage FRC decreased v/q mismatch daytime hypoxia with morbity

Question 35

Costo vertebral skeletal structure 3 main disorders

Answer 35

kyphosis( rounded upper back), scoliosis (S back), Lordosis ( 50 degrees of curvature at the lower back

Question 36

Kyphoscoliosis

Answer 36

common in childhood/ early adol. | when VC < 45% & >110 degree scoliotic angle = compressed lung A-a gradient

Question 37

Mild to moderate Kyphoscoliosis angle

Answer 37

<60 degrees

Question 38

Severe Kyphoscoliosis angle

Answer 38

>100 degrees

Question 39

Pectus excavatum

Answer 39

inward concave of lower sternum

Question 40

Pigeon chest (pectus carinatum)

Answer 40

inward convex of lower sternum

Question 41

Pectus excavatum (severe) puts pressure on.. resulting in decreased...

Answer 41

right side of heart. preload

Question 42

Haller Index

Answer 42

ratio of transverse inside of ribcage and anteroposterior

Question 43

Normal Haller index & severe

Answer 43

2.5, 3.25

Question 44

Nuss procedure

Answer 44

sx for pectus excavatum( idea to get pop back up in small children) use of curved bars to be flipped and push out chest.

Question 45

Pectus Carinatum causes

Answer 45

down syndrome, edwards syndrome, marfans, homocystinuria, morquio syndrome, dwarfism

Question 46

Pectus Carinatum trtmt

Answer 46

chest brace (dental braces idea )

Question 47

Flail Chest

Answer 47

inward movement of unstable portion of the thoracic cage. dehiscence of a median sternotomy, Tv diminished. pneuomothorax risk. Need PPV until stable.

Question 48

diaphragmatic paralysis when? (better upright or supine)?

Answer 48

phrenic nerve neoplastic invasion, after abdominal sx can see. upright

Question 49

diaphragmatic paralysis

Answer 49

open or thoracoscopically, sew slack out in diaphragm into a more normal position

Question 50

Guillain-Barre Syndrome

Answer 50

sudden onset of skeletal muscle weakness or paralysis beginning in legs, resp. insufficiency requiring mech vent in 20-25%, vent support for 2 months

Question 51

Myasthenia gravis & NMB dose

Answer 51

chronnic autoimmune disorder from decrease in functional Ach receptors at NMJ (SMALL NMB dose)

Question 52

Eaton-Lambert Syndrome (myasthenic syndrome)

Answer 52

NDMR = prolonged paralysis & weakness

Question 53

do we use sugammadex or roc for MS pt?

Answer 53

sugammadex

Question 54

Sensory levels above _ __ can associate with impairment of resp muscle activity needed to maintain an adequate vent. (regional never above T10)

Answer 54

T10

Question 55

Intraplural pressure is __mmHg

Answer 55

-4mmHg

Question 56

Cocaine esophageal tear

Answer 56

pneumomediastinum

Question 57

Mediastinal anesthetic

Answer 57

spntaneous, sitting induction, position prone or lateral to reduce severe airway obstruction, conservative fluids

Question 58

Pulmonary embolism pts likely

Answer 58

trauma, prostate or orthopedic, malignancy, immobility, obesity, smokers, oral contraceptives, hormone replacement therapy, antipsychotic meds

Question 59

Pulm Embolism asleep symptoms

Answer 59

hypoten, tachy, hypoxemia, decreased end tidal co2, shock and right vent failure

Question 60

Case study: bone fracture 12-72 hrs. post injury, hypoxia, mental confusion, petechiae

Answer 60

fat embolism