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Advanced Principles III > CV Exam > Flashcards

CV Exam Flashcards

1
Q

PPO FEV1 tell you

A

Airflow

If <40 = increased risk

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2
Q

VO2 max tell you what ?

A

Cardiopulmonary reserve
VO2max < 15 ml/kg/min = increased risk
>15ml/kg/min = average risk

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3
Q

What does DLCO max tell you

A

Parenchymal function
Small amount CO, hold breath 10 seconds, measured

Low sensitity good specificity
PPOP ( predictive post operative product )

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4
Q

5 flights of stairs = VO@ max

A

> 20 ml/kg/min

Favorable

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5
Q

What must be evaluated to anticipate the patient’’s intra operative and post op needs

A

Respiratory function

Post resection lung

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6
Q

Average risk patient , may be extubated immediately post op

A

VO2max >15 ml/kg/min

PPO FEV1 > 40 %

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7
Q

High risk patients will struggle to get off vent , what are the values

A

VO2max < 10

PPO FEV1 < 30 %

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8
Q

INtermediate risk patients , need to assess the patients on an individualized basis , what are the values

A

VO2 Max between 10 -15 ml/kg/min

PPO FEV1 30% -40 %

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9
Q

What are the principal advantages of double lumen tubes

A

Easy to place
Ability to ventilate one or both lungs
Ability to suction either lung

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10
Q

What are the disadvantages of double lumen tubes : ( 4)

A
  1. Size selection
  2. Difficult to place w/ difficult airways
  3. Not optimal for post op ventilation ( must be change out if pt to remain intubated )
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11
Q

All DLTs share what characteristics (4)

A

LONGER BRONCHIAL LUMEN that enters the right or left main bronchus and another shorter tracheal lumen that terminates in the lower trachea

A preformed CURVE that when properly aimed allows preferential entry into a bronchus

Bronchial cuff

Tracheal cuff

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12
Q

Distance from right upper lobe to baring bifurcation is

A

1.5- 2 cm

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13
Q

Carina bifurcation to left mainsten is

A

4- 5 cm

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14
Q

Contraindication for left sided tube

A

Lesions of the airway
Compression of the trachea
Main bronchus by external mass

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15
Q

Right DLT can malposition more than left , so for that reason which DLT is used more ?

A

Left , even for right thoracotomy

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16
Q

MC complication with DLT is

A

Malpositioning

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17
Q

Larger size DLT is probably responsible for what ?

A

Responsible for the slightly increased incidence of hoarseness and vocal cord lesions ( following DLT vs Bronchial blocker )

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18
Q

Table

A

Inflate tracheal cuff
Verify bilateral breath sounds
Inflate endobronchial cuff
Clamp Y pice to endobronchial lumen and open at atmosphere

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19
Q

A bronchial Blocker just be

A

Advanced , positioned and inflated under visualization via flexible bronchoscope

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20
Q

Patient has a diff airway or tracheostomy chose DLT or Bronchial Blocker , already intubated , pediatric lung separation needed ,
?

A

BB.

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21
Q

Doe bronchial blockers allow suctioning ?

A

No

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22
Q

Which has a greater indidence of malposition?

A

BB

Also requires more time than DLT

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23
Q

When is pediatric lung separation needed ?

A

Infection absolute indication of one lung ventilation

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24
Q

During two lung ventilation blood flow to the dependent are averages how much ?

A

60%

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25
Q

What happens to blood flow when one lung is deflated and one lung ventilation is started ?

A

Any blood floe to the deflated lung becomes shunt flow, causing the PaO2 to decrease

A 40% shunt would be anticipated w/o Autoregulation. But the lung have a compensatory mechanism of increasing vascular resistance in hypoxic areas of the lungs , and this diverts some blood flow to areas of better ventilation and oxygenation .

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26
Q

What is HPV

A

A reflex intrapulmonary feedback mechanism in inhomogeneous lung that improves gas exchange and arterial oxygenation

Hypoxia causes pulmonary arteries to vasoconstrict opposite of what happens in the rest of the body ( vasodilation ) with hypoxia.

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27
Q

HPV can increase PVR to what %?

A

50 to 300 %

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28
Q

What meds inhibit HVP

A 
NTG 
Nitroprusside 
Dobutamine 
Isopreterenol ( some B2 agonist )
CCB
Volatiles Mac >1.5 
Hypocapnia
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29
Q

Vasoconstrictive drugs preferentially constrict well oxygenated arteries = reestablishing shunt flow = opposing the HPV effects .

A

Phenylephrine
Epinephrine
Dopamine

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30
Q

Factors that reduce effective of HPV

A
  1. Alkalosis
  2. Hypocapnia
  3. Excessive Vt or PEEP
  4. Hemodiluation
  5. Hypervolemia
  6. Hypothermia
  7. Prostacyclin
  8. Shunt fraction <20% or >80%
  9. Vasodilators , Phosphodiesterase Inhibitor 10.calcium channel blocker
  10. Volatile anesthetic >1.5 MAC
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31
Q

PaO2 from highest to lowest post various lung surgery

A

Pneumonectomy>Lobectomy> Segmentectomy

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32
Q

Smoking is not only a major risk factor for chronic lung disease but also a strong predictor of preop complication . True or false ?

A

True

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33
Q

The neurological innervation to the heart originates from

A

the autonomic nervous system, as well as from sensory fibers

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34
Q

Efferent impulses are transmitted from the _____and ______ to numerous body systems, including the heart

A

Brainstem and hypothalamus

35
Q

Increased sympathetic nervous system increases what ?

A

Heart rate
Inotropy
Rate of AV node discharge ( dromotropy )

36
Q

Preganglionic sympathetic nervous system fibers originate from

A

The cells in the INTERMEDIOLATERAL COLUMNS of the higher thoracic segments of the spinal cord
and
SYNAPSE at the 1st Through 4th or 5th thoracic paravertebral ganglia. ( T1-T4/T5)

37
Q

Postganglionic fibers then travel as the ___,___,and ____ cardiac nerves and the ______nerves

A

Superior, middle and inferior cardiac nerves and throracic visceral neves

Epi cardiac plexus&raquo_space; distributed over the entire ventricular myocardium

38
Q

Postganglionic sympathetic fibers + Postganglionic parasympathetic fibers from cardiac plexus to primarily innervation

A

SA and AV nosed and the atrial myocardium .

39
Q

WHERE DO preganglionic parasympathetic fibers originate ?

A

In the dorsal motor nucleus of the medulla

40
Q

______primarily innervation the SA and AV nodes and the atrial muscle fibers

A

Short postganglionic fibers

41
Q

Function of the parasympathetic nervous system is primarily to slow HR and secondarily to decrease contractility. True or False ?

A

True

42
Q

Main NT of PNS is

A

Ach

43
Q

PNS makes SA node and AV node less excitable ( bradycardia etc…) why ?

A

Bc it increases Potassium permeability = hyperpolarization

44
Q

Where does sensory innervation of the heart come from ?

A

Nerve endings in the walls of the heart, the coronary artery adventitia and the pericardium
They synapse with the posterior gray columns of the spinal cord .&raquo_space;second order neurons&raquo_space;ascend spinothalamic tract&raquo_space; and terminate in the postventral nucleus of the thalamus

45
Q

Preganglionic parasympathetic fibers originate in the

A

Dorsal motor nucleus of the medulla

46
Q

Alpha stimulation = decrease in bronchial secretion. True or false ?

A

True

47
Q

Effects of Isoproterenol in bronchial and pulmonary system

A

Potent bronchial dilator and pulmonary vasodilator

48
Q

Dissecting aortic aneurysm and mitral stenosis place traction on the _____ causing hoarseness

A

RLN

49
Q

Does injury to SLN cause respiratory distress?

A

No

50
Q

Stridor means

A

Acute phase of bilateral RLN damage by unopposed addicted vocal cords, may progress to Resp distress and even death

51
Q

The larynx begin with the ____ and extends to the ______

A

Epiglottis and extends to the cricoid cartilage

52
Q

Adult Larynx begins at what vertebrae and end at which ?

A

CC3-C4 ends at C6

C3- C6 or C4-C6

53
Q

Blood supply to larynx is

A

External carotid which branches into superior thyroid artery

Superior thyroid artery gives rise to the superior laryngeal artery while inferior thyroid artery =infraglottic region of the larynx

54
Q

Endodermis-derived epithelium and the mesoderm contribute to the development of what ?

A

The lungs

55
Q

Development of alveoli until year ____after birth

Lung growth until year ____after birth

A

3 years

2 years

56
Q

Tracheal extends from

A

Cricoid cartilage to the carina

57
Q

How long in the trachea in adult

A

10 to 20 cm

Has 16 to 20 C shaped rings

58
Q

Which is the only cartilage in the trachea that has a comple cartilaginous ring ?

A

Cricoid cartilage

59
Q

When the cartilages disappear it is not called

A

Bronchioles

60
Q

Angle of the right mainstem bronchus is

A

25 to 30 degrees

61
Q

Angle of the left mainstem bronchus is

A

45 degrees

62
Q

Bifurcation of the Right upper lobe is approximately ____cm from the carina

A

2.5

63
Q

C3, C4 C5 innervates the

A

Phrenic nerve

64
Q

Most modern PM are _____and their lead configuration exhibit smaller spikes on the surface of ECG

A

Bipolar

65
Q

Right atrium PM lead = spike in front of which wave form , and area paced ?

A

Spike in front of P wave ,

Atrial depolarization

66
Q

Right ventricle PM lead = spike in front of which wave form , and area paced ?

A

Spike in front of QRS

Ventricular depolarization

67
Q

Spike in front of both P wave and QRS where are the leads ?

A

Leads are both in right atrium and ventricle

68
Q

Indication for Pace,maker

A 
Sinus Node 
AV Node 
Long QT 
HOCM
DCMP
69
Q

Electrical output

A

Measured in mA

It’s the electrical out the PM delivers with each charge

70
Q

Threshold

A

The minimum output that will cause the myocardium to consistently contract or capture

71
Q

Sensitivity

A

The lowest amplitude P or R wave that the pacemaker will recognize as an electrical signal

72
Q

Capture

A

Depolarization of a hear chamber in response to pacemaker electrical outlet

73
Q

Failure to capture

A

When the pacemaker electrical I’ll put fails to cause Myocardial depolarization

74
Q

Failure to sense

A

The pacemaker fails to recognize intrinsic cardiac electrical activity

75
Q

The first letter in the cold identifies

A

the CHAMBER where the pacing electrolytes placed

1= CHAMBER PACED

76
Q

If the first letter is a=
The first letter is V=
If the first letter is D =

A 
A= Right Atrium 
V = Ventricle 
D= Both , Dual
77
Q

The second leather identifies the

A

The chamber where the sensing electrode is placed

2= Chamber sensed

78
Q

If the second letter is O what does that mean

A

No sensing

Pacemaker will paste at asynchronous rate

79
Q

The third letterIdentifies the

A

The pacemaker response to the detection of spontaneous cardiac depolarization and its effect on subsequent pacing stimuli

The device will either inhibit or trigger a piercing stimulus

80
Q

If the third letter is I, T, O or D

A

I= inhibit
T= TRIGGER
O=no sensing , asynchronous
D= inhibit and Trigger in response to sensed intrinsic stimuli

81
Q

The fourth letter represents

A

Rate modulation

82
Q

Fort letter: R represents—- and O represents ——

A 
R = presence of rate modulation
O= It’s absence
83
Q

Fifth letter in final letter identifies

A

Multi site pacing

Advanced Principles III (11 decks)

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