Medicine (Respiratory Diseases)

Question 1

What is asthma?

Answer 1

-Chronic obstructive disease with bronchiolar inflammation and hyperresponsiveness that displays reversible, variable, and recurrent airway obstruction

Question 2

How is asthma classified?

Answer 2

-Mild intermittent: (Less than 2 episodes per week)
-Mild persistent (more than 2 episodes per week)
-Moderate persistent: Daily episodes
-Severe persistent: Continuous symptoms

Question 3

What is status asthmaticus?

Answer 3

-A life threatening condition where a bronchospastic episode does not lead to treatment

Question 4

What are anesthetic considerations for an asthma patient?

Answer 4

-Pre-op optimization
-Prophylactic b2 agonist inhaler
-Avoid Stage II anesthesia
-Use propofol, ketamine, etc (bronchodilators)
-Avoid beta blockers and NSAIDs

Question 5

What is cystic fibrosis?

Answer 5

-Autosomal recessive disease resultin in altered chloride and water transport across epithelial cells. Thick, mucousy secretions in lungs.
-Diagnosed by high sweat chloride concentration

Question 6

What are anesthetic considerations with a cystic fibrosis patient?

Answer 6

-Optimization with pulmonologist
-Rule out active infections
-CMP, LFTs, CXR pre-op
-Avoid nitrous
-No ketamine
-Prophylactic betal blocker
-Need for post-op admission/hospitalization

Question 7

What is COPD?

Answer 7

-An irreversible disease that causes airway obstruction either from chronic bronchitis or emphysema
-Can’t get air out

Question 8

How is COPD classified?

Answer 8

-Stage I through IV based on FEV1/FVC
FEV1 <30%=Stage IV

Question 9

What are anesthetic considerations for a COPD patient?

Answer 9

-Optimized with pulmonologist
-Smoking cessation x6 weeks
-EKG, CXR
-Avoid nitrous
-B2 agonist pre-op

Question 10

What is a pulmonary embolism?

Answer 10

-Acute, partial or complete obstruction in the pulmonary arterial vasculature leading to a ventilation perfusion mismatch.

Question 11

What is Virchows triad?

Answer 11

-Risk factor for PE
-Stasis, damage to endothelium, hypercoagulable state

Question 12

How is PE diagnosed?

Answer 12

-CT PE
-D-dimer highly sensitive

Question 13

How is a PE treated?

Answer 13

-IVC filter if anticoagulation contraindicated
-INR 2-3
-3 months vs lifelong anticoagulation

Question 14

What is the pathphysiology to respiratory issues with COVID?

Answer 14

-Immune response to the virus within lung tissue
-Cytokine storm cna lead to thrombosis and multiple organ involvement
-Can lead to respiratory distress, kidney injury, myocardial injjyr, thrombotic events, multiorgan failure
-Severe cases can progress to pneumonia, ARDS, multiorgan dysfunction