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Apex > 1 Resp Patho > Flashcards

1 Resp Patho Flashcards

1
Q

Bronchodilation: which receptor/g protein/2nd messenger/release. Ends when

A

B2, Gs, Adenylate cyclase, cAMP (2nd), reduces Ca release from SR, bronchodilators. End w pd3 converting cAMP to AMP

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2
Q

NO: which nerves it acts on, stim what

A

Non cholinergic PNS nerves to release VIP and inc NO produc, stim cGMP to dilate

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3
Q

Bronchoconstriction: nerve, release what onto what, G protein, 2nd mess, turned off when

A

CN X, Ach onto M3, Gq to phos C, IP3 (2ND), ca release from SR. Turned off when IP3 to IP2

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4
Q

C fiber mediators that bronchoconstriction

A

Sub p, neurokinin A, calcitonin gene related peptide

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5
Q

Steroids interfere where

A

Block mast cells from stim arachidonic acid leading to leukotrienes

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6
Q

Cromolyn affects what

A

Release of cytokines, leukotrienes, histamine

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7
Q

Methylxanthines affect what

A

PDE to stim cAMP, dec ca release and cause relaxation

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8
Q

Beta 2 ag effect on K

A

Hypokalemia

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9
Q

How anticholinergics work to dilate

A

Antagonize M3, dec IP3 and ca release

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10
Q

Methylxanthines: drug example, side effects when >20 mcg/ml

A

Theophylline. NVD, HA, cant sleep

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11
Q

Theophylline SE when >30 mcg/ml

A

Sz, tachydysrhythmias, CHF

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12
Q

Fev1: Effort ____, declines w ___, nml value

A

Dependent, age,>80% of predicted

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13
Q

FVC: effort ___, M/F nml

A

Dependent. 5L, 3.7L

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14
Q

FEV1/FVC ratio nml

A

80%

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15
Q

FEF 25-75: effort ___, tests what, nml

A

Less effort dependent, middle airway flow, 75-100% predicted

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16
Q

MVV: test of ___,nml

A

Endurance. M: 160L, F: 100

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17
Q

Dlco: test of what, nml

A

Gas exchange, 17-25 ml/min/mmhg

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18
Q

Procedure high to low risk for pulm complic

A

Aortic > thoracic> upper abd = neuro = peripheral vascular > emergency

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19
Q

Which lab test does and doesnt show risk pulm postop complic

A

Does: albumin <3.5. Doesnt: abg and pft

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20
Q

Smoking cessation: when CO and p50 return to normal

A

T1/2 4-6 hr CO. P50 returns 12 hours

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21
Q

Smoking cessation: when pulm func returns and when hepatic enzyme induc subsides

A

6 weeks for both

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22
Q

How to do ARMs

A

PIP to 40 for 8 seconds

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23
Q

Obstructive disease: which tests are normal, low, or hi nml

A

Nml/hi nml: RV, FRC, TLC. Low: ratio and fef 25-75. Low nml: FVC and fev1.

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24
Q

Restrictive disease: tests that are low vs nml

A

Low: FVC, fev1, RV, FRC, tlc. Nml: ratio, 25-75

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25
Q

How to differentiate on spirometry: obstructive, restrictive, fixed

A

Obstruc: concave exp limb. Fixed: flat insp and exp limbs. Restrictive: smaller and shifted right

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26
Q

Flow volume loop: direction of breathing, exp vs insp on chart, vol on chart

A

Clockwise, exp on top insp bottom. Vol increases right to left

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27
Q

Extrathoracic vs intrathoracic obstruction on flow vol loop

A

Extra: insp limb flat, intra: exp limb flat

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28
Q

Asthma: greatest risk factor, tests that are reduced

A

Autopsy. FEV1, fev1/FVC ratio, 25-75 (all imp w dilator tx)

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29
Q

Asthma: what ekg may show, flow vol loop changes not caused by wheeze w asthma

A

R axis dev. Insp or exp limb totally flat

30
Q

Asthma vent settings

A

Limit insp time, prolong exp time, mod permissive hypercapnia

31
Q

Why h2 antag bad in asthma

A

Unopposed h1 stim leading to bronchospasm

32
Q

Bronchospasm tx order

A

02, deepend anesthesia, B2 ag (albuterol), ipratropium inhaled, epi 1 mcg/kg iv, hydrocortisone 2-4 mg/kg to prevent complic later, aminophylline (not Theo), heliox

33
Q

Why restoring paco2 to nml in COPD bad

A

HCO3 in blood hasn’t gone anywhere, risk severe alkalosis and apnea

34
Q

COPD: rely on what for resp drive. Diagnosis when

A

Pa02. Ratio <70% after bronchodilator therapy

35
Q

COPD: avoid block above what, what may risk rupture of blebs/ptx

A

T6, nitrous

36
Q

COPD: tv, other vent consid

A

6-8 ml/kg IBW, inc exp time

37
Q

Causes of auto peep

A

Large tv, inc rr, bronchoconstriction, inc a/w resistance

38
Q

Cardiac fx auto peep

A

Dec venous return, hypotension, overstim cvp and paop

39
Q

Restrictive disease: diagnosis, causes of chronic intrinsic

A

Ratio <70%. Sarcoidosis or amio

40
Q

Restrictive disease: TV, RR, PIP

A

6 ml/kg, 14-18, <30, 1:1

41
Q

Mendelsons syndrome diagnosis

A

Ph <2.5, vol >25 ml

42
Q

First action in aspiration, other actions

A

Tilt head down or to side, upper then lower a/w suction, secure airway, peep, dilators, iv lido

43
Q

Hallmark signs tension ptx

A

Hypoxemia, inc a/w p, tachycardia, hypotension, inc CVP

44
Q

Where chest tube goes ptx

A

2nd IC mid clavicle or 4-5th IC space ant axillary line

45
Q

Chylothorax risk w CVL which side

A

Left

46
Q

Hemothorax: when thoracotomy indicated

A

> 1l initial drainage, >200ml/hr, white on cxr and air leak

47
Q

Hemothorax: when vats ok

A

<150 ml/hr

48
Q

Flair chest chest movement

A

Ribs move in with insp and out with exp

49
Q

High to low risk positioning for VAE

A

Sitting, supine, prone, lateral

50
Q

S/s highest to lowest sensitivity VAE

A

TEE, Doppler (no physio changes), PAP/ETCO2, CO/CVP (modest changes), BP/EKG (collapse)

51
Q

Tx vae order

A

02, flood field, d/c insufflation, L lateral, aspirate air, hemodynamic support

52
Q

Pulm htn: fixed what that’s dependent on what

A

CO, preload

53
Q

PVR calculation, nml

A

(Mean PAP- PAOP) X 80 / co. 150-250

54
Q

Causes inc PVR: ___ temp, drugs, ___ valve disease

A

Low, NO/Ketamine/des, mitral

55
Q

Drugs that decrease PVR

A

Nitric, ntg, pde inhib, prostaglandins, Ccb, ace inhib

56
Q

If elev RA pressure w/inc PVR: do what to prevent r to l shunt or reverse it

A

Reverse causes of inc pulm resistance

57
Q

Drug of choice when too much preload w inc PVR

A

NTG

58
Q

Carboxyhgb: shift where in curve, dx, pt appearance, pulse ox

A

Shift left, co oximetry. Pulse ox falsely elevated. Cherry red not cyanotic

59
Q

Tx carboxyhgb

A

100% 02 until cohgb <5% for 6 hours. Hyperbaric if >25% or symptomatic

60
Q

Risk greatest to least CO with soda lime. Which does compound a

A

Des, iso, sevo. Sevo

61
Q

Drugs you can give down ett

A

Narcan atropine vaso epi lido

62
Q

VC and insp force when need ett

A

<15, <25

63
Q

Pa02 and A-a when need ett at 21%

A

<55 >55

64
Q

Pa02 and Aa at 100% 02 when need ett

A

<200 and >450

65
Q

RR and CO2 when need ett

A

> 40 or <6, >60

66
Q

Best predictors of postop pulm complic from pulm sx

A

FEV1 <40%, dlco <40%, VO2 max <15 ml/kg/min

67
Q

DLT size and insertion depth men v women

A

Men: 39-41, 29 cm. Women: 37-39, 27 cm

68
Q

DLT sizes in peds, when you cant do one

A

8-9 26 fr, 10+ 28-32 fr. If <8 years old

69
Q

Where scope inserted mediastinoscopy, ptx risk which side

A

Ant to trachea post to innominate. Right side

70
Q

Mediastinoscopy: absolute v relative contraindications

A

Absolute: previous one. Relative: trach dev, thoracic aortic aneurysm, SVC obstruction

Apex (21 decks)

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