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Anesthesia based on Nebuchanedzzer II > ITE QBANK Misc 4 > Flashcards

ITE QBANK Misc 4 Flashcards

1
Q

_____ test uses carbon monoxide diffusion to assess the parenchymal function of the lungs.

This is increased with cardiac output, increased lung volume, high blood flow through pulmonary vessels, increased L to R shunt, increased hgb [ ], as this all allows more hgb present to bind larger amount of Carbon monoxide.

A

DLCO

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2
Q

Carbon monoxide binds to hgb at ____x the affinity of oxygen

A

200x

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3
Q

Ratio of deadspace ventilation equation aka Physiologic deadspace equation

A

(PaCO2 - PeCO2) / PaCO2

ie: (80-40) / 80

PeCO2 = expired gas

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4
Q

Postural drainage, chest percussion/vibration, and deep breathing exercises comprise of the three primary components for standard _____

A

chest physiotherapy

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5
Q

_____ utilizes a ventilator device to deliver a high frequency (100-300 cycles/min) of high flow jets of air to the pts respiratory system via a mouthpiece or an endotracheal or tracheostomy tube adaptor.

A

Intrapulmonary percussive ventilation

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6
Q

_______ are handheld devices that produces a flutter sensation during forced exhalation, providing rapidly oscillating intrapulmonary pressure, which may loosen mucus and aid in clearance from airways.

A

Acapella device (flutter)

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7
Q

_________ alternatively provides positive pressure and then negative pressure to a pt’s airway in an attempt to stimulate a pt’s natural cough. (Tracheobronchial toilet)

A

mechanical insufflator-exsufflator (exsufflation)

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8
Q

Carbon monixide poisining shows a PaO2 of ___ and SaO2 of ____ and a _____ acidosis

A

100%, 100% (falsely elevated)

metabolic

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9
Q

Why does pulse ox over-read SpO2 in CO poisoning?

A

std two-wave pulse oximetry is unable to differentiate btwn COHgb and oxyHgb.

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10
Q

During forced exhalation, the lung (Apices/Bases) are emptied first, and airway closure occurs first in the lung (Apices/Bases)

A

apices

bases

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11
Q

Closing capacity =

A

Closing volume + residual volume

it is the volume remaining in the lungs during expiration when the alveoli BEGIN to close

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12
Q

How much does unilateral paralysis of the diaphragm affect FRC? (ie. unilateral interscalene block)

A

No significant reduction

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13
Q

FRC is reduced in morbidly obese pts d/t ______

A

a decrease in expiratory reserve volume (ERV)

*remember that FRC = ERV + RV

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14
Q

Acute respiratory acidosis is compensated by an increase in serum HCO3- of __mmol/L for every __ mmHg increase in PaCO2

A

2

10

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15
Q

Lung resistance can be divided into ____ and ____

A

airway resistance and elastic resistance

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16
Q

Airway resistance affects _____, which directly varies with Peak inspiratory pressure (PIP)

A

airflow into the lungs

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17
Q

Elastic resistance affects _____, (aka pulmonary compliance), which directly affects both Peak inspiratory pressure and Plateau pressure

A

expansion of the lungs

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18
Q

Which ventilator mode?

Super PEEP, high CPAP, maximal recruitment, maximize gas exchange

A

APRV

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19
Q

Situations that increase airway resistance but not elastic resistance, like in bronchospasm, kinked ETT, airway secretions, mucus plug, PIP is increased, and Pplateau is _______

A

unchanged.

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20
Q

Situations that increase elastic resistance (or decrease compliance), like intrinsic pulmonary diseases, ascites, abdominal insufflation, tension pneumo, and trendelenburg, will result in Increased PIP and (Pplateau is _______

A

increased as well

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21
Q

Increased PIP, Unchanged Pplateau

Affected by situations that increase _______

A

Airway Resistance

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22
Q

Increased PIP, Increased Pplateau

Affected by situations that increase _______

A

Elastic resistance (or compliance)

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23
Q

Ventilation without perfusion

A

deadspace

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24
Q

Perfusion without ventilation

A

shunt

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25
Q

______ position reduces FRC, TLC, Lung compliance and chest wall compliance. May relocate fixed ETT into R mainstem bronchus

A

Trendelenburg - abdominal contents are shifted cephalad

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26
Q

________ can be determined by body plethysmography, helium dilution technique, nitrogen washout

A

FRC

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27
Q

A capnogram from a pt w/ a single lung transplant d/t COPD will show a _______ pattern, reflecting the difference in fxn btwn the healthy transplanted lung and the diseased naive lung

A

double peak

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28
Q

Capnography may be utilized during cardiac arrest to indicate return of cardiac output and spont circulation if ETCO2 > ____ mmHg

A

20 mmHg

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29
Q

Preferred management of foreign body aspiration includes _____ to examine the airways and ______ to retrieve the foreign object

A

flexible bronchoscopy

rigid bronchoscopy

*avoid positive pressure ventilation

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30
Q

Intervention that MOST improves pulmonary function following major open upper abdominal surgery?

A

mid-thoracic epidural anesthesia

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31
Q

Carbon monoxide causes a (Rightward/Leftward) shift of the hgb dissociation curve.

A

Leftward

*High affinity of CO for hgb

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32
Q

The half-life of carboxyhemoglobin depends on ________

A

ventilatory rate

  • at rest: 6 hours
  • with exercise: 1 hour
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33
Q

Quitting smoking causes a (Rightward/Leftward) shift of the hgb dissociation curve.

A

Rightward

*improved O2 delivery to tissues

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34
Q

Pts with cystic fibrosis have (greater/lesser) bronchial reactivity to irritating stimuli and histamine than pts w/o CF

A

Greater

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35
Q

Are anticholinergic medications useful in pts with cystic fibrosis?

A

no- AVOID

- further dehydrate and worsen the viscosity of airway secretions

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36
Q

Airway closure occurs when the intrathoracic pressure during expiration exceeds the airways’ intrinsic ability to maintain patency.

Airway closure begins (Earlier/Later) in pts with emphysema compared to pts w/ nl lungs

A

earlier

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37
Q

Resistance to airflow varies with the fourth power of the airway _____

A

radius

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38
Q

Lung abscesses occur d/t primary infections (ie/ aspiration PNA), and are comonly caused by _____ bacteria

A

anaerobic

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39
Q

An _________ obstruction produces a flow-volume loop w/ a plateaued expiratory curve, and the flow rate is usually decreased

A

intrathoracic airway obstruction

- ie: distal tracheal tumor or mediastinal mass

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40
Q

Impairment of airflow during the EXPIRATORY PHASE is the result of a variable ________ airway obstruction

A

INTRAthoracic airway obstruction or COPD

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41
Q

Impairment of airflow during the INHALATION PHASE is the result of a variable ________ lesion

A

EXTRAthoracic lesion

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42
Q

As alveoli become smaller, pulmonary surfactant [ ] (Increases/Decreases) and surface tension is (More/Less) effective

A

Increases

more effectively reduced

*and vice versa

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43
Q

____ muscles help with inhalation.

____ muscles help with exhalation

A

intercostal

external/internal oblique

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44
Q

Storage of RBC or Hypothermia shifts the oxygen-hgb dissociation curve to the ____

A

Left

favor oxygen retention on hgb

45
Q

2,3-DPG is a product of cellular metabolism, shifts the oxygen-hgb dissociation curve to the ____

A

Right

favor oxygen unloading

46
Q

BIPAP adds pressure support ventilation (PSV) to CPAP.
CPAP without the PSV support of BPAP solely acts to prevent _______, through optimization of the V/Q ratio and increases alveolar oxygen delivery.

A

the collapse of both upper and lower airways

- CPAP only improves oxygenation without supporting ventilation

47
Q

BIPAP adds _______ to CPAP.

A

pressure support ventilation (PSV)

- ensures alveolar ventilation

48
Q

Do not use Positive airway pressures in BIPAP > ___ cmH2O or a pressure support level > ___ cm H2O given concern for gastric insufflation

A

25 cm H2O

8 cm H2O

49
Q

Impairment of both the inspiratory and expiratory phase occurs w/ a __________ obstruction or _________ obstruction

A

fixed upper airway obstruction or fixed large airway obstruction

50
Q

Both ventilation and perfusion are lower in the (apical/basal) alveoli.

A

apical

51
Q

(Ventilation/Perfusion) difference is steeper in the upper portion of the lungs, and the V:Q can be said to be infinite in zone 1. (alveolar dead space which is ventilated but not perfused)

A

Perfusion

52
Q

Zone 1 is normally minimal in spontaneously breathing individual, but can be substantial if either pulmonary perfusion is (high/low) or alveolar pressure is (high/low)

A

Zone 1 is normally minimal in spontaneously breathing individual, but can be substantial if either pulmonary perfusion is (high/low) or alveolar pressure is (high/low)

53
Q

Salicylate poisoning has a mixed respiratory _____ and a metabolic _____

A

respiratory alkalosis

metabolic acidosis

54
Q

Bronchospasm results in an increase in the resistance in the ________ of the lung, resulting in increase peak pressures

A

small airways

55
Q

Bronchospasm results in:
(increase/decrease) in static compliance of the lung

(increase/decrease) in dynamic compliance of the lung

A

No affect on static compliance
- static compliance is measured during periods of zero airflow (plateau pressure)

decrease in dynamic compliance

56
Q

change in volume for a given change in pressure

A

compliance

57
Q

change in pressure for a given change in volume

A

elastance

58
Q 
These will all (increase/decrease) lung static compliance:
Pneumothorax, 
pulmonary edema, 
PNA, 
pneumonectomy,
intubation
A

decrease

- all of these decreases lung volume, and greater plateau pressure is required to maintain similar lung vol

59
Q

These will all (increase/decrease) chest wall compliance and thus, the entire respiratory system:

  • Abdominal insufflation
  • Abdominal distension
  • Abd/thoracic eschar/scarring
  • Thoracic deformities
A

decrease
- chest wall compliance and therefore, total respiratory system compliance can be improved through the use of muscle relaxation

60
Q

How does pulmonary embolism affect static or dynamic compliance?

A

it doesn’t

- no affect on gas flow through endobronchial tree

61
Q

_________ compliance is determined by the resistance to airflow through the small airways of the lung

A

dynamic

62
Q

_________ compliance is determined by the ability of the lung to expand in the setting of static positive airway pressure administration.

A

static

63
Q

______ compliance can be estimated by examining the difference between the peak pressures and the plateau pressures in a volume-cycled ventilatory mode w/ an inspiratory hold

A

Dynamic

64
Q

_______ compliance can be estimated by taking the difference between plateau pressure and the PEEP in a volume-cycled ventilatory mode

A

static

65
Q

Pulmonary manifestations of Rheumatoid arthritis

A
  1. pleural effusions
  2. nodules
  3. fibrosis
  4. chest wall motion may be restricted -> decreased lung volumes and V/Q mismatching
66
Q

Cardiac manifestations of Rheumatoid arthritis

A
  1. restrictive pericarditis

2. cardiac tamponade

67
Q

Anterior subluxation of C1 on C2 (atlantoaxial instability) may occur in up to __% of pts w/ RA

A

40%

68
Q

___________ can monitor pleural pressures and allowing for calculation of a transpleural/transpulmonary pressure gradient

A

esophageal manometry

69
Q

Hyperoxia and reactive oxygen species effects on the CNS. Target SpO2 should be < 100%

A
  1. visual disurbances d/t injury of retina
  2. peripheral neuropathies
  3. paralysis
  4. sz and death
  5. cerebral vasoconstriction
70
Q

(True/false) formation of atelectasis increases with age in adults

A

FALSE

71
Q

The decrease PaO2 seen with advanced age is not d/t an increase in atelectasis, but d/t an increase in ______, which causes air to be trapped behind closed airways (mostly at bases) halfway through expiration

A

closing capacity

72
Q

Hypoxemia can be caused by Atelectasis and Intermittent airway closure
- which one causes a pure shunt (V/Q = zero) and which one causes low V/Q, but not zero?

A

atelectasis = pure shunt
- V/Q = 0

Intermittent airway closure
- low V/Q

73
Q

atelectasis behaves as a ______ ventilatory defect

A

restrictive

74
Q

Carboxyhemoglobin levels > __% along with neuro impairment from carbon monoxide poisoning is an indication for hyperbaric oxygen therapy

A

25%

75
Q

Absolute indications for one-lung ventilation (4)

A
  1. Protective isolation of each lung, to prevent contamination of healthy lung (abscess, infected cyst), massive hemorrhage
  2. Control of distribution of ventilation to only one lung
  3. Unilateral lung lavage
  4. VATS
76
Q

(Supraclavicular/Axillary) nerve block avoids the risk of phrenic nerve block or pneumothorax, but requires multiple injections

A

Axillary

77
Q

the ____________ nerve is blocked with a field block to cover tourniquet pain for UE surgery

A

intercostobrachial nerve block (T2)

78
Q

Is [H+] a strong ion?

A

no, water does not completely dissociate

79
Q

Normal strong ion difference is ___, and will increase in states of alkalosis (ie. dehydration and vomiting)

A

40

80
Q

Herpes zoster most to least common nerve roots affects

A 
Thoracic >
Opthalmic division of trigeminal n >
Maxillary division of the trigeminal n >
Cervical spinal roots >
Sacral spinal roots
81
Q

Spinal cord stimulator most significantly affects the ______ of the spinal cord and prevents conduction of chronic pain sensation by triggering larger, faster transmitting nerves and closing the “gate” to smaller, slower nerves

A

dorsal horn

82
Q

Can you use TENS therapy during first trimester of pregnancy for pain?

A

no contraindication

83
Q

__________ is an umbrella term for multiple disorders including:

  • Diabetic peripheral neuropathy
  • complex regional pain syndrome
  • postherpetic neuralgia
  • multiple sclerosis
A

Neuropathic pain

- treatment varies

84
Q

Lower extremity complex regional pain syndrome is treated with serial _______, which can cause ejaculatory problems, especially when b/l blocks are done

A

serial lumbar plexus sympathetic blocks

85
Q

Erections are activated via (sympathetic/parasympathetic) mechanisms

A

parasympathetic

- not affected by nerve blocks

86
Q

Why is phantom limb pain so difficult to tx?

A

No specific therapy has been shown thru randomized controlled trials to be beneficial

87
Q

______ is a specialized form of nerve block which uses targeted, intense cold to damage select nerves and cause temporary or semipermanent conduction blockade

A

Cryoanalgesia

88
Q

Nerve regeneration after cryoanalgesia usually occurs over _____ (time frame)

A

1-3 months

89
Q

Sympathetic presynaptic nerve cell bodies are located in the ______ of the spinal cord segments _____

A

lateral horn

T1-L2

90
Q

Sympathetic post-synaptic nerve cell bodies are called _____

A

ganglia

91
Q

Indications for sympathetic block

A
  1. Visceral pain (abd cancers)
  2. neuropathic pain (CRPS)
  3. Vascular diseases (Raynaud syndrome)
92
Q

Name that sympathetic ganglion block:

- related to Upper extremities and thorax

A

stellate ganglion

93
Q

Name that sympathetic ganglion block:

- done with posterior approach under the 12th rib

A

celiac plexus

94
Q

Name that sympathetic ganglion block:

- done via posterior approach to aim at anterior L1-L5

A

Lumbar sympathetic chain

95
Q

Stellate ganglion located _____

A

btwn C6-C7

96
Q

Celiac plexus ganglion located _____

A

beside aorta and IVC at L1

97
Q

Lumbar sympathetic chain ganglion located _____

A

anterior to L1-L5

98
Q

_______ is a inhibitory neurotransmitter of central nociceptor terminals

A

Glycine

*similar to GABA

99
Q

Carbamazepine toxicity is associated w/ what type of symptoms?

A

anticholinergic

  • hyperthermia
  • flushing
  • dry mouth
  • urinary retention
100
Q

Why do you have to be careful when using carbamazepine with other drugs?

A

induces/enhances cytochrome p450 system

- faster metabolism of antiepileptic drugs, birth control ect.

101
Q

Anticholinergic sx

A

dry as a bone,
mad as a hatter,
blind as a bat
hot as a hare

*atropine fever

102
Q

1 mg of intrathecal morphine = __ mg of epidural morphine

A

10 mg

103
Q

1 mg of epidural morphine - ___ mg of IV morphine

A

10 mg

104
Q

1 mg of IV morphine = __ mg of PO morphine

A

3 mg

105
Q

When used as an infusion at 50 mcg/kg/min, propofol has ________ effects on the respiratory system

A

bronchodilatory

and

respiratory depressant

106
Q

Administration of ______ is most effective for the treatment of vasogenic cerebral edema

A

steroids

107
Q

Inhaled volatile anesthetics will have an (Increased/Decreased) pharmacodynamic effect in children with cerebral palsy

A

Increased

108
Q

The increase in creatinine clearance that occurs with pregnancy returns to prepregnant levels how long post partum?

A

8-12 weeks postpartum

109
Q

How much does the DOA of epidural bupivacaine get affected by the addition of epinephrine?

A

not much

Anesthesia based on Nebuchanedzzer II (38 decks)

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