Respiratory pathophysiology 2

Question 1

A forced vital capacity is the

Answer 1

volume of air that can be exhaled after a maximal inhalation

Question 2

What are the normal values of forced vital capacity?

Answer 2

male: 4.8 L
female: 3.7 L

Question 3

What is the forced expiratory volume?

Answer 3

volume of air that can be exhaled after a maximal inhalation in 1 second

Question 4

Forced expiratory volume depends on

Answer 4

the patient’s effort

Question 5

Forced expiratory volume declines

Answer 5

with age (predicted values take this into account)

Question 6

FEV1 to FVC ratio compares

Answer 6

volume of air expired in 1 second and total volume of air expired

Question 7

FEV1/FVC ratio is useful in diagnosis of

Answer 7

obstructive vs. restrictive disease

Question 8

FEV1/FVC ratio is __________ with obstructive disease & ________ with restrictive disease

Answer 8

<70% suggest obstructive disease; usually normal

Question 9

The forced expiratory flow at 25-75% vital capacity is ____________ with obstructive disease & ___________ with restrictive disease

Answer 9

usually reduced; usually normal

Question 10

The maximum voluntary ventilation is the

Answer 10

maximum volume of air that can be inhaled and exhaled over the course of 1 minute

Question 11

The best test of endurance is the

Answer 11

maximum voluntary ventilation

Question 12

Normal maximum voluntary ventilation values for males & females are

Answer 12

male: 140-180 L
female: 80-120 L

Question 13

Flow-volume loops allow us to

Answer 13

differentiate between obstructive & restrictive respiratory diseases

Question 14

The patient begins inhalation from

Answer 14

residual volume and stops when they achieve total lung capacity

Question 15

Inhalation produces a waveform that moves from

Answer 15

right to left with a negative deflection

Question 16

Exhalation occurs when the patient exhales back to

Answer 16

residual volume

Question 17

Exhalation produces a waveform that moves from

Answer 17

left to right with a positive deflection

Question 18

________ is the width of the loop

Answer 18

Vital capacity

Question 19

All of the following are independent risk factors for postoperative pulmonary complications EXCEPT:
a. age >65 years
b. chronic obstructive pulmonary disease
c. congestive heart failure
d. asthma

Answer 19

d. asthma

Question 20

Independent risk factors for postoperative pulmonary complications can be categorized as

Answer 20

patient-related
procedure-related
diagnostic testing

Question 21

Patient examples of risk factors for postoperative pulmonary complications include

Answer 21

old age (>60 years), COPD, CHF, smoking, ASA >2

Question 22

Procedure examples of risk factors for postoperative pulmonary complications include

Answer 22

surgery >2 hrs, GA, aortic or abdominal surgery

Question 23

Diagnostic examples of risk factors for postoperative pulmonary complications include

Answer 23

albumin <3.5 g/dL (indicates poor nutritional status)

Question 24

Short term benefits of smoking cessation include

Answer 24

a reduction in carboxyhemoglobin (improved P50), but this does not reduce the risk of postoperative pulmonary complications

Question 25

Risk reduction strategies for postoperative pulmonary complications include:

Answer 25

smoking cessation (at least 6 weeks) consider anesthetic options besides GA teach patient to use pulmonary recruitment maneuvers treat active infections (prophylaxis is not indicated) treat expiratory airflow obstruction with bronchodilators and corticosteroids employ alveolar recruitment maneuvers (ARMs)+ PEEP

Question 26

Factors that have NOT been shown to increase risk of postoperative pulmonary complications for non-thoracic surgery include:

Answer 26

mild/moderate asthma ABG analysis pulmonary function testing

Question 27

Short term effects of smoking cessation include

Answer 27

carbon monoxide t1/2= 4-6 hrs P50 returns to near normal in 12 hours

Question 28

Return of pulmonary function after smoking takes at least 6 weeks. This includes:

Answer 28

airway function mucociliary clearance sputum production pulmonary immune function hepatic enzyme induction also subsides after 6 weeks

Question 29

A peak airway pressure of _______ is required for initial reopening of the atelectatic regions.

Answer 29

30 cm H2O

Question 30

Increasing the PIP to ________________________ appears to reverse anesthesia-induced atelectasis almost completely

Answer 30

40 cm H2O for 8 seconds

Question 31

Postoperative strategies to reduce postoperative pulmonary complications include

Answer 31

utilize effective analgesia (intercostal nerve block, neuraxial opioids, PCA) use pulmonary recruitment maneuvers

Question 32

A patient with severe kyphoscoliosis is expected to have a reduced: (select 2) a. FEV1/FVC ratio b. FRC c. FEF 25-75% D. FEV1

Answer 32

B. FRC D. FEV1

Question 33

Obstructive disease is characterized by

Answer 33

small airway obstruction and increased resistance to expiratory flow getting air out is the problem

Question 34

Restrictive disease is characterized by a

Answer 34

proportionate reduction in all of the lung volumes along with poor compliance small lung volumes are the problem

Question 35

Patients with obstructive disease have a decreased

Answer 35

FEV1/FVC

Question 36

Patients with obstructive disease can have a normal or decreased

Answer 36

FEV1 & FVC

Question 37

Patients with restrictive disease have a decreased

Answer 37

FEV1 & FVC

Question 38

Patients with restrictive disease have a ___________ FEV1/FVC & FEF 25-75%

Answer 38

normal

Question 39

The spirometry waveform of an obstructive disease looks like:

Answer 39

the expiratory limb has a concave shape

Question 40

The spirometry waveform of a restrictive disease looks like:

Answer 40

the restrictive loop is smaller and right shifted

Question 41

What does a fixed lesion look like on spirometry?

Answer 41

the inspiratory and expiratory limbs are flat- someone smashed my ice cream cone & it needs to be "fixed"

Question 42

Examples of a fixed lesion include

Answer 42

tracheal stenosis

Question 43

Sometimes can upper airway lesion is a problem during inspiration and expiration. Other times the upper airway lesion is

Answer 43

variable and only creates the obstruction during inspiration OR during expiration

Question 44

A ____________ obstruction has obstruction with inspiration.

Answer 44

extrathoracic

Question 45

A __________ obstruction has obstruction with expiration

Answer 45

intrathoracic

Question 46

A patient with asthma experiences bronchospasm immediately following tracheal intubation. This is MOST likely the result of: a. mast cell degranulation b. decreased sympathetic tone c. histamine release d. vagal stimulation

Answer 46

d. vagal stimulation