ITE QBANK Misc 4 Flashcards
_____ 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.
DLCO
Carbon monoxide binds to hgb at ____x the affinity of oxygen
200x
Ratio of deadspace ventilation equation aka Physiologic deadspace equation
(PaCO2 - PeCO2) / PaCO2
ie: (80-40) / 80
PeCO2 = expired gas
Postural drainage, chest percussion/vibration, and deep breathing exercises comprise of the three primary components for standard _____
chest physiotherapy
_____ 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.
Intrapulmonary percussive ventilation
_______ 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.
Acapella device (flutter)
_________ 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)
mechanical insufflator-exsufflator (exsufflation)
Carbon monixide poisining shows a PaO2 of ___ and SaO2 of ____ and a _____ acidosis
100%, 100% (falsely elevated)
metabolic
Why does pulse ox over-read SpO2 in CO poisoning?
std two-wave pulse oximetry is unable to differentiate btwn COHgb and oxyHgb.
During forced exhalation, the lung (Apices/Bases) are emptied first, and airway closure occurs first in the lung (Apices/Bases)
apices
bases
Closing capacity =
Closing volume + residual volume
it is the volume remaining in the lungs during expiration when the alveoli BEGIN to close
How much does unilateral paralysis of the diaphragm affect FRC? (ie. unilateral interscalene block)
No significant reduction
FRC is reduced in morbidly obese pts d/t ______
a decrease in expiratory reserve volume (ERV)
*remember that FRC = ERV + RV
Acute respiratory acidosis is compensated by an increase in serum HCO3- of __mmol/L for every __ mmHg increase in PaCO2
2
10
Lung resistance can be divided into ____ and ____
airway resistance and elastic resistance
Airway resistance affects _____, which directly varies with Peak inspiratory pressure (PIP)
airflow into the lungs
Elastic resistance affects _____, (aka pulmonary compliance), which directly affects both Peak inspiratory pressure and Plateau pressure
expansion of the lungs
Which ventilator mode?
Super PEEP, high CPAP, maximal recruitment, maximize gas exchange
APRV
Situations that increase airway resistance but not elastic resistance, like in bronchospasm, kinked ETT, airway secretions, mucus plug, PIP is increased, and Pplateau is _______
unchanged.
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 _______
increased as well
Increased PIP, Unchanged Pplateau
Affected by situations that increase _______
Airway Resistance
Increased PIP, Increased Pplateau
Affected by situations that increase _______
Elastic resistance (or compliance)
Ventilation without perfusion
deadspace
Perfusion without ventilation
shunt
______ position reduces FRC, TLC, Lung compliance and chest wall compliance. May relocate fixed ETT into R mainstem bronchus
Trendelenburg - abdominal contents are shifted cephalad
________ can be determined by body plethysmography, helium dilution technique, nitrogen washout
FRC
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
double peak
Capnography may be utilized during cardiac arrest to indicate return of cardiac output and spont circulation if ETCO2 > ____ mmHg
20 mmHg
Preferred management of foreign body aspiration includes _____ to examine the airways and ______ to retrieve the foreign object
flexible bronchoscopy
rigid bronchoscopy
*avoid positive pressure ventilation
Intervention that MOST improves pulmonary function following major open upper abdominal surgery?
mid-thoracic epidural anesthesia
Carbon monoxide causes a (Rightward/Leftward) shift of the hgb dissociation curve.
Leftward
*High affinity of CO for hgb
The half-life of carboxyhemoglobin depends on ________
ventilatory rate
- at rest: 6 hours
- with exercise: 1 hour
Quitting smoking causes a (Rightward/Leftward) shift of the hgb dissociation curve.
Rightward
*improved O2 delivery to tissues
Pts with cystic fibrosis have (greater/lesser) bronchial reactivity to irritating stimuli and histamine than pts w/o CF
Greater
Are anticholinergic medications useful in pts with cystic fibrosis?
no- AVOID
- further dehydrate and worsen the viscosity of airway secretions
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
earlier
Resistance to airflow varies with the fourth power of the airway _____
radius
Lung abscesses occur d/t primary infections (ie/ aspiration PNA), and are comonly caused by _____ bacteria
anaerobic
An _________ obstruction produces a flow-volume loop w/ a plateaued expiratory curve, and the flow rate is usually decreased
intrathoracic airway obstruction
- ie: distal tracheal tumor or mediastinal mass
Impairment of airflow during the EXPIRATORY PHASE is the result of a variable ________ airway obstruction
INTRAthoracic airway obstruction or COPD
Impairment of airflow during the INHALATION PHASE is the result of a variable ________ lesion
EXTRAthoracic lesion
As alveoli become smaller, pulmonary surfactant [ ] (Increases/Decreases) and surface tension is (More/Less) effective
Increases
more effectively reduced
*and vice versa
____ muscles help with inhalation.
____ muscles help with exhalation
intercostal
external/internal oblique
Storage of RBC or Hypothermia shifts the oxygen-hgb dissociation curve to the ____
Left
favor oxygen retention on hgb
2,3-DPG is a product of cellular metabolism, shifts the oxygen-hgb dissociation curve to the ____
Right
favor oxygen unloading
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.
the collapse of both upper and lower airways
- CPAP only improves oxygenation without supporting ventilation
BIPAP adds _______ to CPAP.
pressure support ventilation (PSV)
- ensures alveolar ventilation
Do not use Positive airway pressures in BIPAP > ___ cmH2O or a pressure support level > ___ cm H2O given concern for gastric insufflation
25 cm H2O
8 cm H2O
Impairment of both the inspiratory and expiratory phase occurs w/ a __________ obstruction or _________ obstruction
fixed upper airway obstruction or fixed large airway obstruction
Both ventilation and perfusion are lower in the (apical/basal) alveoli.
apical
(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)
Perfusion
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)
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)
Salicylate poisoning has a mixed respiratory _____ and a metabolic _____
respiratory alkalosis
metabolic acidosis
Bronchospasm results in an increase in the resistance in the ________ of the lung, resulting in increase peak pressures
small airways
Bronchospasm results in:
(increase/decrease) in static compliance of the lung
(increase/decrease) in dynamic compliance of the lung
No affect on static compliance
- static compliance is measured during periods of zero airflow (plateau pressure)
decrease in dynamic compliance
change in volume for a given change in pressure
compliance
change in pressure for a given change in volume
elastance
These will all (increase/decrease) lung static compliance: Pneumothorax, pulmonary edema, PNA, pneumonectomy, intubation
decrease
- all of these decreases lung volume, and greater plateau pressure is required to maintain similar lung vol
These will all (increase/decrease) chest wall compliance and thus, the entire respiratory system:
- Abdominal insufflation
- Abdominal distension
- Abd/thoracic eschar/scarring
- Thoracic deformities
decrease
- chest wall compliance and therefore, total respiratory system compliance can be improved through the use of muscle relaxation
How does pulmonary embolism affect static or dynamic compliance?
it doesn’t
- no affect on gas flow through endobronchial tree
_________ compliance is determined by the resistance to airflow through the small airways of the lung
dynamic
_________ compliance is determined by the ability of the lung to expand in the setting of static positive airway pressure administration.
static
______ 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
Dynamic
_______ compliance can be estimated by taking the difference between plateau pressure and the PEEP in a volume-cycled ventilatory mode
static
Pulmonary manifestations of Rheumatoid arthritis
- pleural effusions
- nodules
- fibrosis
- chest wall motion may be restricted -> decreased lung volumes and V/Q mismatching
Cardiac manifestations of Rheumatoid arthritis
- restrictive pericarditis
2. cardiac tamponade
Anterior subluxation of C1 on C2 (atlantoaxial instability) may occur in up to __% of pts w/ RA
40%
___________ can monitor pleural pressures and allowing for calculation of a transpleural/transpulmonary pressure gradient
esophageal manometry
Hyperoxia and reactive oxygen species effects on the CNS. Target SpO2 should be < 100%
- visual disurbances d/t injury of retina
- peripheral neuropathies
- paralysis
- sz and death
- cerebral vasoconstriction
(True/false) formation of atelectasis increases with age in adults
FALSE
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
closing capacity
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?
atelectasis = pure shunt
- V/Q = 0
Intermittent airway closure
- low V/Q
atelectasis behaves as a ______ ventilatory defect
restrictive
Carboxyhemoglobin levels > __% along with neuro impairment from carbon monoxide poisoning is an indication for hyperbaric oxygen therapy
25%
Absolute indications for one-lung ventilation (4)
- Protective isolation of each lung, to prevent contamination of healthy lung (abscess, infected cyst), massive hemorrhage
- Control of distribution of ventilation to only one lung
- Unilateral lung lavage
- VATS
(Supraclavicular/Axillary) nerve block avoids the risk of phrenic nerve block or pneumothorax, but requires multiple injections
Axillary
the ____________ nerve is blocked with a field block to cover tourniquet pain for UE surgery
intercostobrachial nerve block (T2)
Is [H+] a strong ion?
no, water does not completely dissociate
Normal strong ion difference is ___, and will increase in states of alkalosis (ie. dehydration and vomiting)
40
Herpes zoster most to least common nerve roots affects
Thoracic > Opthalmic division of trigeminal n > Maxillary division of the trigeminal n > Cervical spinal roots > Sacral spinal roots
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
dorsal horn
Can you use TENS therapy during first trimester of pregnancy for pain?
no contraindication
__________ is an umbrella term for multiple disorders including:
- Diabetic peripheral neuropathy
- complex regional pain syndrome
- postherpetic neuralgia
- multiple sclerosis
Neuropathic pain
- treatment varies
Lower extremity complex regional pain syndrome is treated with serial _______, which can cause ejaculatory problems, especially when b/l blocks are done
serial lumbar plexus sympathetic blocks
Erections are activated via (sympathetic/parasympathetic) mechanisms
parasympathetic
- not affected by nerve blocks
Why is phantom limb pain so difficult to tx?
No specific therapy has been shown thru randomized controlled trials to be beneficial
______ is a specialized form of nerve block which uses targeted, intense cold to damage select nerves and cause temporary or semipermanent conduction blockade
Cryoanalgesia
Nerve regeneration after cryoanalgesia usually occurs over _____ (time frame)
1-3 months
Sympathetic presynaptic nerve cell bodies are located in the ______ of the spinal cord segments _____
lateral horn
T1-L2
Sympathetic post-synaptic nerve cell bodies are called _____
ganglia
Indications for sympathetic block
- Visceral pain (abd cancers)
- neuropathic pain (CRPS)
- Vascular diseases (Raynaud syndrome)
Name that sympathetic ganglion block:
- related to Upper extremities and thorax
stellate ganglion
Name that sympathetic ganglion block:
- done with posterior approach under the 12th rib
celiac plexus
Name that sympathetic ganglion block:
- done via posterior approach to aim at anterior L1-L5
Lumbar sympathetic chain
Stellate ganglion located _____
btwn C6-C7
Celiac plexus ganglion located _____
beside aorta and IVC at L1
Lumbar sympathetic chain ganglion located _____
anterior to L1-L5
_______ is a inhibitory neurotransmitter of central nociceptor terminals
Glycine
*similar to GABA
Carbamazepine toxicity is associated w/ what type of symptoms?
anticholinergic
- hyperthermia
- flushing
- dry mouth
- urinary retention
Why do you have to be careful when using carbamazepine with other drugs?
induces/enhances cytochrome p450 system
- faster metabolism of antiepileptic drugs, birth control ect.
Anticholinergic sx
dry as a bone,
mad as a hatter,
blind as a bat
hot as a hare
*atropine fever
1 mg of intrathecal morphine = __ mg of epidural morphine
10 mg
1 mg of epidural morphine - ___ mg of IV morphine
10 mg
1 mg of IV morphine = __ mg of PO morphine
3 mg
When used as an infusion at 50 mcg/kg/min, propofol has ________ effects on the respiratory system
bronchodilatory
and
respiratory depressant
Administration of ______ is most effective for the treatment of vasogenic cerebral edema
steroids
Inhaled volatile anesthetics will have an (Increased/Decreased) pharmacodynamic effect in children with cerebral palsy
Increased
The increase in creatinine clearance that occurs with pregnancy returns to prepregnant levels how long post partum?
8-12 weeks postpartum
How much does the DOA of epidural bupivacaine get affected by the addition of epinephrine?
not much
