ITE QBANK Misc 4 Flashcards by Nebuchadnezzer II

_____ 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

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Carbon monoxide binds to hgb at ____x the affinity of oxygen

200x

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Ratio of deadspace ventilation equation aka Physiologic deadspace equation

(PaCO2 - PeCO2) / PaCO2

ie: (80-40) / 80

PeCO2 = expired gas

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

chest physiotherapy

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_____ 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

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_______ 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)

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_________ 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)

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

100%, 100% (falsely elevated)

metabolic

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

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

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

apices

bases

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Closing capacity =

Closing volume + residual volume

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

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

No significant reduction

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FRC is reduced in morbidly obese pts d/t ______

a decrease in expiratory reserve volume (ERV)

*remember that FRC = ERV + RV

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

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Lung resistance can be divided into ____ and ____

airway resistance and elastic resistance

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

airflow into the lungs

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

expansion of the lungs

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Which ventilator mode?

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

APRV

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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.

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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

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Increased PIP, Unchanged Pplateau

Affected by situations that increase _______

Airway Resistance

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Increased PIP, Increased Pplateau

Affected by situations that increase _______

Elastic resistance (or compliance)

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Ventilation without perfusion

deadspace

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Perfusion without ventilation

shunt

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______ 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)

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

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

Cardiac manifestations of Rheumatoid arthritis

1. 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%

1. visual disurbances d/t injury of retina 2. peripheral neuropathies 3. paralysis 4. sz and death 5. 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)

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

(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)

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

1. Visceral pain (abd cancers) 2. neuropathic pain (CRPS) 3. 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