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Surgery > Chapter 21 > Flashcards

Chapter 21 Flashcards

1
Q

Tidal volume

A

The amount of air inspired or expired during nl respiration

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2
Q

FRC

A

The amount of air contained in the lungs after nl expiration

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3
Q

VC

A

The amount of air exhaled following maximal inspiration and forced expiration

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4
Q

RV

A

The amount of air remaining in the lungs after maximal expiration

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5
Q

FEV1

A

The volume of air exhaled in 1 second with a maximum expiratory effort

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6
Q

Criteria for operative risk for pulmonary resection

A

Preoperative FEV1:
>40% predicted: little increased risk
30-40% predicted: increased risk of pulmonary complications
<30% predicted: prohibitive risk

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7
Q

Etiologies of hypoxemia

A

Hypoventilation
Diffusion gradient
V/Q mismatch

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8
Q

Presence of a new solitary nodule in a pt with smoking hx

A

Must be assumed to be a lung CA until proven otherwise

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9
Q

What is the most common cause of cancer-related death in men and women

A

Lung CA

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10
Q

____ of lung cancer is non-small cell lung CA

A

80%

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11
Q

What percentages of NSCLC are resectable?

5-yr survival?

A

20%

70%

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12
Q

What is the cornerstone of therapy for stage I and stage II dz for NSCLC?

A

Surgical resection

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13
Q

What has demonstrated a clear benefit in stage II and III dz for NSCLC?

A

Adjuvant therapy

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14
Q

Who are considered not to be operative candidates, particularly with contralateral positive nodes?

A

Stage IIIB

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15
Q

What are signs of inoperability in lung CA?

A

Bloody pleural effusion
Horner syndrome
SVC syndrome
Distant metastases

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16
Q

What is the central purpose of respiration?

A

Deliver oxygen to erythrocytes and clear carbon dioxide

This enables the body’s cells to undergo aerobic metabolism to efficiently produce ATP

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17
Q

What does gas exchange in respiration consist of?

A

Ventilation
Blood-gas interface
Perfusion

18
Q

Ventilation

A

The process by which atmospheric air travels to the alveoli

19
Q

Blood-gas interface

A

The site of gas exchange

20
Q

Perfusion

A

Whereby blood passes through this interface

21
Q

How is the pressure gradient required for air movement generated?

A

By the primary and accessory respiratory muscles

22
Q

What is the upper airway composed of?

A

Mouth
Pharynx
Larynx

23
Q

What is the conducting zone of the lung composed of?

A

The trachea and the first 16 generations of the airways

This zone is the anatomical dead space because there is an absence of alveoli

24
Q

What comes after the conducting zone?

A

17th-19th generations: respiratory bronchioles (transition zone)
Generations 20-23- lined with alveolar ducts and sacs (respiratory zone)

25
Q

Composition of conducting airways distal to the pharynx

A

Have cartilaginous walls with minimal smooth muscle

Lined with ciliated epithelium interspersed with mucus-secreting goblet cells

26
Q

Smokers and pathology

A

Demonstrate abnormalities in both mucous production and ciliary motility that contribute to their difficulties with secretion clearance

27
Q

Bronchiectasis

A

A condition in which the bronchi are dilated and a loss of ciliary action occurs
Secretions pool and can become chronically infected, a situation that may be associated with hemoptysis

28
Q

What is the transition zone composed of?

A

Membranous and terminal bronchioles

They do not contain cartilage and are innervated by the autonomic nervous system.

29
Q

Histologic morphology of the respiratory zone

A

Contains 300 million alveoli

30
Q

What is the critical component of the alveoli that is integral for movement?

A

The elastin that is embedded within the basal lamina in the alveolar septal interstitium

31
Q

What are the two major types of alveolar epithelial cells?

A

Type I cells: the major lining cells, large, flat, squamous cells with cytoplasmic extensions and are primarily responsible for gas exchange
Type II cells: Granular pneumocyte that are thicker and are responsible for producing surfactant

32
Q

Where are surfactant levels decreased?

A

Respiratory distress syndrome
Acute pancreatitis
Smokers

33
Q

How is ventilation achieved?

A

Achieved by air movement to and from the alveoli
Accomplished by a decrease in intrathoracic pressure relative to the atmosphere when the diaphragm contracts and the thoracic cavity expands

34
Q

What occurs when large volumes of air are required?

A

The external intercostal muscles contract, which further expands the thoracic cavity

35
Q

How is ventilation assessed?

A

By the measurement of the partial pressure of arterial carbon dioxide

36
Q

What is the driving pressure for airflow through the entire system?

A

The difference between the alveolar pressure and pressure at the airway opening (atmospheric pressure)

37
Q

What are the components of alveolar pressure?

A

Elastic recoil pressure and the pleural pressure

38
Q

Hypoxemia

A 
Clinically manifested as low oxygen tension in the arterial blood
Typically results from:
-Hypoventilation
-Diffusion gradients
-Shunt
-Ventilation-perfusion mismatch
39
Q

Causes of hypoventilation

A

Drugs
Mechanical impairments of the chest wall
Paralysis of the respiratory muscles

40
Q

What can cause arterial hypoxemia?

A

Any interstitial lung process such as collagen vascular dz, sarcoidosis, and idiopathic interstitial fibrosis

41
Q

Shunt

A

The fraction of blood that enters the systemic arterial system without passing through a ventilated portion of the lung

42
Q

Causes of shunt

A

Occur due to intracardiac communications such as in congenital heart disease, arteriovenous malformations of the lung, lung consolidation, and vasodilators such as nitroprusside

Surgery (30 decks)

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