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Co-Existing Disease 1 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

3 sever complications for adults with common cold within 2 wks preop?

A
  1. Cardiac arrest
  2. Pneumonia
  3. Prolonged intubation due to increase sputa
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2
Q

How long should intubation be postponed after common cold in adults?

A

2 weeks

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3
Q

What 4 things should you remember to do for adults common cold?

A
  1. Hydrate
  2. Reduce secretions (anti cholinergic)
  3. Limit airways manipulation (LMA)
  4. +/- bronchodilators
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4
Q

Max amount of air a person can expel from the lungs after a max inhalation?

A

Vital capacity

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5
Q

In restrictive lung disease, is vital capacity increased or decreased?

A

Decreased

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6
Q

In obstructive lung disease, is vital capacity increased or decreased?

A

Normal to slightly decreased

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7
Q

Volume of air that can forcibly be blown out in one second, after full inspiration?

A

FEV1

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8
Q

Normal FEV1 values?

A

80-120%

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9
Q

VC equation in female:

A

(21.78-.101a) x h

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10
Q

VC equation in male:

A

(27.63-.112a) x h

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11
Q

Resting volume of the lungs is the balance between what?

A

Elastic recoil pulling the lung in and chest wall out

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12
Q

Obstructive lung disease FRC?

A

Increased; greater chest wall elastic recoil

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13
Q

Restrictive lung disease FRC?

A

Decrease

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14
Q

Obstructive lung disease mechanics:

A

Lung recoil < CW recoil

-increased resting lung volumes (TLC and FRC)

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15
Q

Restrictive lung disease mechanics:

A

CW recoil < lung recoil

-decreased resting lung volume (TLC and FRC)

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16
Q

Is asthma obstructive or restrictive?

A

Obstructive

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17
Q

Bronchial tubes are hyperresponsive and airways become inflamed and produce excess mucus and the muscles around the airways tighten making the airways narrower?

A

Asthma

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18
Q

Atopic asthma triggers?

A

Genetic tendency

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19
Q

What 4 things can the OR causes asthma triggers?

A
  1. Allergens
  2. Pharamcologic agents
  3. Infections
  4. Emotional stress
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20
Q

What is the abnormal autonomic regulation with asthma?

A

Mast cell release mediators which interact with ANS. Mediators directly or indirectly cause bronchoconstriction.

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21
Q

How much does the maximum mid-expiratory flow (MMEF) decrease with asthma?

A

<20% of normal

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22
Q

What does severe asthma V/Q mismatch leads to in PaO2?

A

<60mmHg on RA

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23
Q

What does PaCO2 rises with ?

A

FEV1 <25%

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24
Q

What does asthma fatigue also lead to?

A

Hypercarbia

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25
Q

What is the normal eosinophil count?

A

<500

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26
Q

What are the 2 rescue asthma drugs?

A
  1. B2 adrenergic agonist

2. Anticholinergics

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27
Q

During acute asthma attack, does theophylline offer benefit if using inhaled B-agonist?

A

No

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28
Q

During acute asthma attack, what 3 things are NOT recommended?

A
  1. Antibiotics
  2. Aggressive hydration
  3. Mucolytic
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29
Q

What are leukotriene modifiers?

A

Leukotriene receptor antagonists that are used for long-term control and prevent asthma symptoms

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30
Q

Are leukotriene modifiers quick or slow?

A

Work slowly

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31
Q 
Salbutamol/albuterol 
Levosalbutamol/levalbuterol 
Pirbuterol 
Epinephrine 
Racemic epinephrine 
Ephedrine 
Terbutaline
A

Short acting bronchodilators

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32
Q

Which is the big gun in short acting bronchodilators?

A

Terbutaline

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33
Q 
Salmeterol 
Clenbuterol 
Formoterol 
Bambuterol 
Indacaterol
A

Long acting bronchodilators

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34
Q

Does not respond to routine treatment, considered life threatening?

A

Status asthmaticus

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35
Q

What 5 things should be done with status asthmaticus?

A
  1. O2 over 90%
  2. B2 agonists metered dose
  3. IV corticosteroids
  4. Magnesium sulfate
  5. Oral leukotriene inhibitors
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36
Q

What should peek expiratory flow be in preop for asthma?

A

> 80%

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37
Q

What should be considered in emergency surgery for asthma?

A

Regional

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38
Q

What 5 agents have limited to no histamine release for asthma?

A
  1. Propofol
  2. Ketamine (increase secretions so give anticholinergic first)
  3. Sevo
  4. Fent
  5. Muscle relaxants
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39
Q

What are the 3 important “L” words for asthma anesthetic maintenace?

A

LTA, LMA, lidocaine

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40
Q

What does an i/e ratio need to look like for asthma?

A

Need longer expiratory phase

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41
Q

Should you use higher or lower dose of glycopyrrolate when reversing with neostigmine?

A

Higher

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42
Q

Should you use steroids for acute asthma response?

A

No because takes awhile

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43
Q

Destroys elastic recoil, decreased bronchial wall rigidity, gas trapping, prolonged expiratory phase???

A

COPD

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44
Q

What color is an individual with emphysema and chronic bronchitis?

A

Pink for emphysema

Blue for chronic bronchitis

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45
Q

4 things that are with chronic bronchitis?

A
  1. Mucus hypersecretion
  2. Inflammation
  3. Perichonchiolar fibrosis
  4. Airway obstruction
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46
Q

What does emphysema have?

A

Loss of elastic recoil

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47
Q

Which is more common in older individuals?

A

Emphysema

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48
Q

Which has early and late cough?

A

Early: chronic bronchitis
Late: emphysema

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49
Q

Which has early and late dyspnea?

A

Late: chronic bronchitis
Early: emphysema

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50
Q

What does chronic bronchitis and emphysema FEV1 look like?

A

Decreased

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51
Q

What does chronic bronchitis and emphysema PaO2 look like?

A

Chronic bronchitis: decrease

Emphysema: increase

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52
Q

What does chronic bronchitis and emphysema PaCO2 look like?

A

Chronic bronchitis: increase

Emphysema: normal to decrease

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53
Q

What does chronic bronchitis and emphysema chest x-ray look like?

A

Chronic bronchitis: large heart

Emphysema: small heart

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54
Q

How do you compensate emphysema?

A

Hyperventilation

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55
Q

Increased or decreased CO with chronic bronchitis?

A

Increased

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56
Q

Why does chronic bronchitis increase CO?

A

Compensate for lack of O2, heart reacts by releasing adenosine, which increases CO

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57
Q

What can chronic bronchitis pts develop if given too much supplemental oxygen?

A

Type 2 respiratory failure

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58
Q

Low oxygen and normal or low CO2 levels

A

Type 1 respiratory failure

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59
Q

Low oxygen with high CO2

A

Type 2 respiratory failure

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60
Q

What does type 2 respiratory failure have, O2 or CO2 drive?

A

Hypoxic drive only

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61
Q

Stage 1: mild FEV1?

A

> 80%

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62
Q

Stage 2: moderate FEV1?

A

50-80%

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63
Q

Stage 3: severe FEV1?

A

30-50%

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64
Q

Stage 4: very severe FEV1?

A

<30%

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65
Q

PaCO2 and PaO2 with chronic bronchitis?

A

PaCO2: >45
PaO2: <60

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66
Q

Carboxyhemoglobin shifts oxygen curve to what?

A

Left

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67
Q

What can 6-8 weeks of decrease in carboxygemoglobin levels and increase in P50 of oxyhemoglobin cause?

A

Hepatic enzymes return to normal

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68
Q

Are oral steroids recommended for stable COPD?

A

No

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69
Q

What can high doses of nebulized B-agonists cause in chronic bronchitis?

A

Tachyarrhythmia’s and hypokalemia

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70
Q

Nebulized anticholinergics can cause what in chronic bronchitis?

A

Increase sputum viscosity

71
Q

4 different types of lung volume expansion maneuvers:

A
  1. Deep breathing exercise
  2. Incentive spirometry
  3. Chest physical therapy
  4. Positive pressure breathing techniques
72
Q

What 3 things to do for a pneumothorax perioperatively?

A
  1. Low pressure e
  2. No PEEP
  3. Increase expiratory time
73
Q

Pulmonary arteries constrict in presence of hypoxia without hypercapnia, redirecting blood flow to alveoli with a higher oxygen content

A

Hypoxic pulmonary vasoconstriction

74
Q

What is the most important factor for HPV to be depend on?

A

PAO2

75
Q

Which 2 things can inhibit HPV?

A

Vasodilator drug

Volatile anesthetics

76
Q

Which drugs does not inhibit HPV?

A

IV anesthetics

77
Q

11 things to inhibit hypoxic pulmonary vasoconstriction:

A
  1. Increase CO
  2. Hypothermia
  3. Acidosis/alkalosis
  4. Increase PVR
  5. Vasodilators
  6. Isoproterenol
  7. CCB
  8. Hypocapnia
  9. PEEP
  10. High frequency ventilation
  11. Nitrous oxide
78
Q

HPV functions best when of the lung being hypoxic?

A

30-70%

79
Q

HPV is thought to reduce blood flow to operative lung by how much?

A

50%

80
Q

What could lead to enlargement and rupture of bullae and result in development of tension pneumothorax?

A

Nitrous oxide

81
Q

Ventilatory anesthetic choice for COPD: 3

A

Increase TV and slow breathing rate, change I:E ratio, no PEEP

82
Q

Which dermatone region should be goal for regional anesthetic for COPD?

A

T10 or below

83
Q

What should be avoided as resultant phrenic nerve palsy may further compromise respiratory function?

A

Interscalene block

84
Q

Chronic necrotizing infection of bronchi and bronchioles with abnormal dilatation

A

Bronchiectasis

85
Q

4 things to manage bronchiectasis:

A
  1. Antibiotics
  2. Postural drainage
  3. DLT
  4. No instruments of nares
86
Q

Off-white, yellow or green, and opaque. Indicates presence of large numbers of WBCs, especially neutrophilic granulocytes.

A

Purulent sputum

87
Q

Autosomal recessive genetic disorder. Abnormal transport of Cl- and Na+ across an epithelium, leading to thick, viscous secretions. Diagnosed with sweat Cl- plus cough, purulent sputum chronic pan sinusitis.

A

Cystic fibrosis

88
Q

4 treatments for cystic fibrosis:

A
  1. Bronchodilator therapy
  2. Aerosol iced meds that loosen secretions
  3. Dornase (human deoxyribonuclease that breaks down DNA in sputum to decrease viscosity)
  4. Antibiotic therapy
89
Q

Restrictive pulmonary disease include (3)

A
  1. Acute intrinsic pulmonary disorders
  2. Chronic intrinsic pulmonary disorders
  3. Extrinsic disorders (pleura, chest wall, diaphragm, neuromuscular function)
90
Q

What is an acute intrinsic restrictive pulmonary disease?

A

Pulmonary edema

91
Q

What 2 things does acute pulmonary edema result from?

A

Increased capillary pressure and permeability

92
Q

What does pulmonary edema look like on chest x-ray?

A

Bat wing or butterfly pattern

93
Q

Tubular outline of an airway made visible by filling of surrounding alveoli by fluid or inflammatory exudates

A

Air bronchogram

94
Q

5 characteristics of pulmonary edema:

A
  1. Extreme dyspnea
  2. Tachypnea
  3. HTN
  4. Tachycardia
  5. Diaphoresis
95
Q

Aspiration can result in what 3 things:

A
  1. Atelectasis
  2. Leakage of IV fluid into lungs
  3. Pulmonary edema
96
Q

Treatment of pulmonary edema (4)

A
  1. O2
  2. PEEP
  3. Bronchodilation
  4. Corticosteroid treatment
97
Q

Neurogenic pulmonary edema can lead to what 3 things:

A
  1. Vasoconstriction
  2. Blood volume shift into pulmonary circulation
  3. Increased pulmonary capillary pressure
98
Q

Does naloxone speed up resolution of opioid-induced pulmonary edema?

A

No

99
Q

What hts can cause altitude pulmonary edema?

A

8,000-16,000ft

100
Q

What can re-expansion of collapsed lung cause?

A

Pulmonary edema if done too rapidly

101
Q

When is mechanical ventilation and PEEP required of hypoxemia being present?

A

O2 saturation <90%

102
Q

What should TV and RR be for intraop pulmonary edema?

A

TV 4-8ml/kg

RR 14-18breaths/min

103
Q

What is pulmonary fibrosis

A

Chronic intrinsic restrictive pulmonary disorder

104
Q

Pulmonary HTN PAP and PAWP:

A

PAP: >25
PAWP: <15

105
Q

Thickened alveolar membrane slows gas exchange. Loss of lung compliance may decrease alveolar ventilation.

A

Fibrotic lung disease

106
Q

What is FEV1/FVC ratio of pulmonary fibrosis?

A

Preserved

107
Q

What does chest x-ray look like with pulmonary fibrosis?

A

Ground-glass or honeycomb

108
Q

What 5 things worsen pulmonary HTN?

A
  1. Hypoxia
  2. Hypercapnia
  3. Acidosis
  4. Hypothermia
  5. Extreme catecholamine surges
109
Q

Systemic granulomatous disorder most often found in interstitium

A

Sarcoidosis

110
Q

Symptom of sarcoidosis:

A

Hypercalcemia

111
Q

Diffuse interstitial granulomatous reactions that can lead to pulmonary fibrosis

A

Hypersensitivity pneumonitis

112
Q

Excessive smooth muscle in airways, lymphatic, and blood vessels that occurs in reproductive aged females

A

Lymphangioleiomyomatosis (LAM)

113
Q

4 pulmonary function tests for LAM:

A
  1. Restrictive and obstructive disease
  2. Decrease diffusing capacity
  3. Decrease all volumes
  4. Decrease FEV1/FEV ratio
114
Q

Diseases due to disorders of thoracic cage which interfere with lung expansion

A

Chronic extrinsic restrictive lung disease

115
Q

5 chronic extrinsic restrictive lung disease:

A
  1. Obesity
  2. Deformities of costovertberal skeletal structure
  3. Deformities of sternum
  4. Flail chest
  5. Neuromuscular disorders
116
Q

Swayback, spine of person curves inward at lower back

A

Lordosis

117
Q

Anterior flexion of vertebral column (abnormal rounded upper back) more than 50 degree of curve

A

Kyphosis

118
Q

Sideways curve to spine. S or C shape. Lateral curve with rotation of vertebral column

A

Scoliosis

119
Q

Respiratory failure in kyphoscoliosis occurs when VC and degree is what?

A

VC <45%

Degree >110

120
Q

Mild to moderate kyphoscoliosis angle

A

<60

121
Q

Severe kyphoscoliosis angle

A

> 100

122
Q

Inward con cavity of lower sternum

A

Precuts excavatum

123
Q

Outward protuberance of upper, middle, or lower sternum

A

Pectins carinatum (pigeon chest)

124
Q

Severe cases of pectus excavatum: 2

A

RA may be compressed and mitral valve prolapse

125
Q

Ratio of transverse diameter (horizontal distance of inside of rib cage) and anteroposterior diameter (shortest distance between vertebrae and sternum)

A

Haller index

126
Q

Haller index normal chest

A

2.5

127
Q

Haller index considered with severe?

A

> 3.25

128
Q

Genetic disorder of chest wall. Makes chest jut out because of unusual growth of rib and breastbone cartilage

A

Pectus carinatum (pigeon chest)

129
Q

Inward movement of unstable portion of thoracic cage while remainder of thoracic cage moves outward during inspiration (rocking horse)

A

Flail chest

130
Q

Treatment for flail chest:

A

Positive pressure ventilation

131
Q

What drug reverses mild degree of bronchial constriction due to increased parasympathetic tone?

A

Anticholinergic bronchodilating drugs

132
Q

Sudden onset of skeletal muscle weakness or paralysis typically beginning in legs

A

Guillain-Barré syndrome

133
Q

Chronic autoimmune disorder from decrease in functional AChR at NMJ

A

Myasthenia gravis

134
Q

What is MG sensitive to?

A

Non depolarizing muscle relaxants

135
Q

Non depolarize NMB drugs can cause prolonged paralysis or weakness

A

Eaton-Lambert syndrome

136
Q

What drug to use in multiple sclerosis?

A

No sux and yes nondepolarizing NMB

137
Q

Sensory levels above what can associate with impairment of respiratory muscle activity needed to maintain adequate ventilation?

A

T10

138
Q

Good position for pts to breathe adequately

A

Sitting

139
Q

Position for pts if have severe obstruction?

A

Lateral or prone

140
Q

Adheres to lungs

A

Visceral pleura

141
Q

Adheres to thoracic wall, mediastinum, and diaphragm

A

Parietal pleura

142
Q

Potential space between visceral and parietal pleurae

A

Pleural cavity

143
Q

Transpulmonary pressure

A

4

144
Q

Intrapleural pressure

A

756 (-4)

145
Q

Intra alveolar pressure

A

760 (0)

146
Q

Inflammation of pleura that causes sharp pain with breathing

A

Pleurisy

147
Q

Excess fluid in pleural space (thoracentesis)

A

Pleural effusion

148
Q

Buildup of air or gas in pleural space

A

Pneumothorax

149
Q

Visceral pleura become fibrous-surgical decortication

A

Pleural fibrosis

150
Q

Central compartment of thoracic cavity. Contains all thoracic viscera and structures except lungs. Mobile region due to looseness of connective tissue and elasticity of lungs and parietal pleura

A

Mediastinum

151
Q

5 symptoms of asleep pulmonary embolism:

A
  1. Hypotension
  2. Tachycardia
  3. Hypoxemia
  4. Decreased end tidal CO2
  5. Shock and RV failure
152
Q

Occlusion of dermal capillaries by fat emboli result in what?

A

Petechial rash

153
Q

Cessation of smoking for what time causes greatest pulmonary complications?

A

2-4wks

154
Q

DLCO increase or decrease in any condition which affects the affective alveolar surface area?

A

Decrease

155
Q

What should be used during taping of chest in positioning lung case?

A

Max inflation

156
Q

What is an overhydrated pt at risk of (2)

A
  1. RV failure

2. Pulmonary edema

157
Q

Mean pulmonary venous pressure

A

5

158
Q

Pulmonary artery BP mean

A

15

159
Q

When does trachea bifurcates?

A

T5

160
Q

Right bronchus angle

A

25

161
Q

Left bronchus angle

A

45

162
Q

When does hypoxic pulmonary vasoconstriction occur?

A

<70

163
Q

Acidosis and hypercapnia SVR and PVR?

A

Decrease SVR

Increase PVR

164
Q

Alkalosis and hypcapnia SVR and PVR?

A

Increase SVR

Decrease PVR

165
Q

What causes HPV?

A

N2O

166
Q

Ventilated lung and non ventilated lung vent mode?

A

Ventilated lung PEEP

Non ventilated lung CPAP

167
Q

Why use atoprine, glyco before airway instrumentation?

A

To decreased oral secretions

168
Q

How should atropine, glyco be given for awake airway instrumentation?

A

Intramuscular to avoid undesired side effects (tachycardia and psychosis)

169
Q

All intrinsic laryngeal muscles except what are innervated by recurrent laryngeal nerve?

A

Cricothryroids

170
Q

Superior laryngeal nerve block should pass about where?

A

2-4 mm inferior to greater Cornu of hyoid bone

171
Q

Superior laryngeal nerve block provides where (4)

A
  1. Base of tongue
  2. Posterior surface of epiglottis
  3. Aryepiglottic fold
  4. Arytenoids
172
Q

Recurrent laryngeal nerve block provides where (2)

A

Vocal fold and trachea

173
Q

Does trans-tracheal block affect motor function?

A

No

174
Q

What can blockade of vagus nerve lead to? (5)

A
  1. Bradycardia
  2. Systole
  3. Reflex tachycardia
  4. Syncope
  5. Dysphasia secondary to vocal cord paralysis

Co-Existing Disease 1 (8 decks)

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