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Tex Wes Semester 2 Savage > Obstructive Exam 4 > Flashcards

Obstructive Exam 4 Flashcards

all you gotta do is breathe

1
Q

Q. Most patients describe their symptoms as a cold, what is this common disease process that can lead to preop/postop complication?
A. Upper Respiratory Infection
B. Lower GI bug
C. Allergies
D. OSA

A

A. Upper Respiratory Infection

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2
Q

Q. Noninfectious URI can present in two ways?
A. viral origin
B. bacterial origin
C. vasomotor
D. allergic

A

C. vasomotor -
D. allergic -

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3
Q

Q. What is essentially a waste of time and money in the pre op setting?
A. Blood work
B. Viral panel
C. PFTs
D. Mobility screen

A

B. Viral panel-

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4
Q

Q. Most studies regarding URIs are specific to what group?
A. Pulmonary disorders
B. Paraplegics
C. Pacific Islanders
D. Pediatrics

A

D. Pediatrics -

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5
Q

Q. What tool is available to score our URI patients?
A. COUGH
B. COLDS
C. CROUP
D. WHEEZE

A

B. COLDS -

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6
Q

Q. If you delay surgery due to a severe URI, how long should you postpone?
A. 5 weeks
B. 6 weeks
C. 7 weeks
D. 8 weeks

A

B. 6 weeks-

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7
Q

Q. How should a CRNA anesthetically manage patients with URIs?
A. Desflurane induction
B. nebulized local anesthetic
C. ETT two sizes down from planned.
D. LMA

A

B. nebulized local anesthetic D. LMA

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8
Q

Q. What is something we do with our URI patients to create a smooth emergence? (as long as it’s not contraindicated).
A. Deep extubation
B. Over pressurization of volatiles prior to waking.
C. Propofol push of 30 mg to keep your patient relaxed.
D. 5 puffs of albuterol

A

A. Deep extubation-

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9
Q

Q. Intraop/postop adverse events associated with URIs include
A. Laryngospasm
B. Hypoxemia
C. Hypotension
D. Low SVO2
E. Bronchospasm

A

A. Laryngospasm -
B. Hypoxemia -

E. Bronchospasm-

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10
Q

Q. What do patients respond well to if they become hypoxic w/ an URI
A. N2O for bronchodilation
B. Recruitment maneuvers
C. O2
D. PEEP of 10 for 2 plus hours

A

C. O2

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11
Q

Q. Asthma could be defined as?
A. inflammatory are histamine, prostaglandin D2, and leukotrienes-
B. inflammatory cascade leads to infiltration of the airway mucosa-
C. chronic inflammation of the mucosa of the lower airways-
D. thickening of the basement membrane and smooth muscle mass-

A

A,B,C and D

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12
Q

Q. This is a life threatening airway pathology
A. Status asthmaticus
B. Status epilepticus
C. Status asbestosis
D. Status emphysematosus

A

A.

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13
Q

Q. Regarding asthma hx, what should you look out for?
A. Sleep score
B. Hospital admission frequency
C. Prior intubations
D. Coexisting diseases

A

B. Hospital admission frequency
C. Prior intubations
D. Coexisting diseases

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14
Q

Q. A particular sign/s that allows for the diagnosis of asthma?
A. SOB & wheezing
B. chest pain
C. Partial or full recovery of airflow rates post bronchodilator
D. hypertensive crisis

A

A. SOB & wheezing
C. Partial or full recovery of airflow rates post bronchodilator

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15
Q

Q. Tools/test that allow for the diagnosis of lung function.
A. PCT
B. FEV1/FVC
C. MVV
D. PLCOT

A

B. FEV1/FVC
C. MVV

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16
Q

Q. What shape would we see in our expiratory loop in asthmatic?
A. downward scooping of the expiratory limb
B. plateau
C. loss of dynamic compression
D. High FEV values

A

A. downward scooping of the expiratory limb-

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17
Q

Q. This capacity and or volume changes in asthma attack?
A. FVC
B. FRC
C. TLC
D. IRV

A

A. FVC-
B. FRC-

D. IRV-

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18
Q

Q. During a carbon monoxide diffusing test, what do you expect in asthmatic?
A. limited diffusion
B. increased diffusion
C. no diffusion
D. unchanged diffusion

A

D. unchanged diffusion-

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19
Q

Q. What volume loop would an asthma attack resemble?
A. sarcoidosis
B. fibrosus
C. emphysema
D. pneumonia

A

C. emphysema

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20
Q

Q. Most common ABG findings in asthmatics?
A. acidosis
B. hypocarbia
C. alkalosis
D. hypercarbia

A

B. hypocarbia-
C. alkalosis-

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21
Q

Q. When is it likely we would see an increase in PaCO2?
A. FEV of 15%
B. FEV of 33%
C. FEV of 95%
D. FEV of 23%

A

A. FEV of 15%-

D. FEV of 23%-

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22
Q

Q. Tachypnea and hyperventilation in asthma are linked to what?
A. hypercarbia
B. pain
C. Reduced TLC
D. neural reflexes of the lungs

A

D. neural reflexes of the lungs-

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23
Q

Q. What would of right axis shift clue you into on your EKG in asthmatics?
A. pulmonary HTN
B. PE
C. pleural effusion
D. pneumonitis

A

A. pulmonary HTN-

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24
Q

Q. What findings would you find on xray in an asthmatic?
A. Hilar lines indicating congestion.
B. Hyperinflation
C. Pneumo
D. tracheal deviation

A

A. Hilar lines indicating congestion.-
B. Hyperinflation-

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25
Q

Q. What can mimic asthma?
A. Trauma
B. Trach
C. Acute surgery to the upper airway
D. pleuritis

A

A. Trauma-
B. Trach -
C. Acute sugery to the upper airway-

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26
Q

Q. Medication options for Asthmatics?
A. Steroids
B. Beta agonist
C. LTE inhibitors
D. mast cell stabilization

A

A. Steroids-
B. Beta agonist-
C. LTE inhibitors-
D. mast cell stabilization-

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27
Q

Q. Non pharmacologic therapy that utilizes lasers?
A. BEAM procedure
B. HEAT procedure
C. Thermoplasty procedure
D. Alveoli popping procedure

A

C. Thermoplasty procedure-

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28
Q

Q. FEV1s greater than this have minimal asthma symptoms?
A. 48%
B. 39%
C. 51%
D. 67%

A

C. 51%-
D. 67%-

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29
Q

Q. Why is the use of heat, laser, or cautery an issue for us?
A. Makes CRNAs sweaty
B. Airway fire
C. Patients prefer the cold
D. poor epithelialization post op

A

B. Airway fire-

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30
Q

Q. These factors increase our risk of bronchospasm?
A. upper abdominal and oncologic surgery-
B. oncologic surgery-
C. recent attack-
D. pain response-

A

A. upper abdominal and oncologic surgery-
B. oncologic surgery-
C. recent attack-
D. pain response-

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31
Q

Q. What blood cell type mirrors the degree of inflammation in asthmatics
A. neutrophils
B. eosinophils
C. basophils
D. macrophages

A

B. eosinophils-

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32
Q

Q. What are some physical assessments to look for in our asthmatics?
A. accessory muscle use
B. audible wheezing
C. pink rosy skin
D. breath holding capability

A

A. accessory muscle use-
B. audible wheezing-

33
Q

Q. Your patient is having an acute asthma attack, what is your first line treatment?
A. NABA
B. LABA
C. GABA
D. SABA

A

D. SABA-

34
Q

Q. Your patient is taking Advair (fluticasone), how much hydrocortisone you give?
A. 25 mg preop, 50 mg intraop
B. 0 mg preop, 20 mg postop
C. 100 mg one time bolus
D. 0 mg preop, 0 mg postop - no need, HPA suppression unlikely

A

D. 0 mg preop, 0 mg postop - no need, HPA suppression unlikely

35
Q

Q. Patients should be free of and have what prior to surgery regarding asthma?
A. free of wheezing
B. mountain climbing capabilities
C. PEF of >80% of predicted
D. Increased TLC volumes

A

A. free of wheezing
C. PEF of >80% of predicted

36
Q

Q. These patients have similar expiratory flows to asthmatics but all the time?
A. COPD
B. asbestosis
C. pneumonia
D. covid-19

A

A. COPD -

37
Q

Q. This defining characteristic of COPD, that separates it from asthma?
A. lazy lungs
B. reduced tissue recoil
C. genetic predisposition
D. excessive breath holding

A

B. reduced tissue recoil-

38
Q

Q. Besides smoking and other chemical exposures, what can lead to COPD? (select all)
A. pollution
B. α1-antitrypsin deficiency
C. male sex
D. poor gestational development

A

A. pollution-
B. α1-antitrypsin deficiency-

D. poor gestational development-

39
Q

Q. Just like asthma, what can exacerbate copd?
A. bronchospasm
B. pleural spasm
C. biceps femoris spasm
D. recurrent laryngeal nerve injury

A

A. bronchospasm-

40
Q

Q. Common COPD findings? (select all that apply)
A. pleuritis
B. decrease in the FEV1:FVC 75%
C. greater decrease in FEV btw 25% and 75%
D. decreased diffusing capacity-

A

B. decrease in the FEV1:FVC 75%-
C. greater decrease in FEV btw 25% and 75% -

41
Q

Q. Besides an increase in TLC over time, what volumes of capacities are increased in COPD?
A. VC
B. RV
C. FRC
D. ERV

A

B. RV-
C. FRC-

42
Q

Q. These confirm emphysema on radiologic findings?
A. Bullae
B. Blebs
C. Blisters
D. Bulbs

A

A. Bullae-

43
Q

Q. An advantage to a large RV and FRC in COPD?
A. Big chest makes you look awesome
B. Such large volumes help increase the elastic recoil
C. You float better
D. Better oxygenation

A

B. Such large volumes help increase the elastic recoil-

44
Q

Q. BMI, degree of obstruction, level of dyspnea, and exercise tolerance to assess prognosis are useful in what index?
A. PULM
B. BALM
C. BLEET
D. BODE

A

D. BODE

45
Q

Q. What often remains normal in COPD patients until the later stages of disease?
A. EKG
B. ABG
C. WBC
D. LFT

A

B. ABG

46
Q

Q. Besides an ABG what other blood test should you review in suspected COPD?
A. alpha1-antitrypsin
B. eosinophils
C. albumin levels
D. BOLT level in seconds

A

A. alpha1-antitrypsin-
B. eosinophils-

47
Q

Q. The main class of drugs to manage symptoms in COPD patients?
A. anticholinesterases
B. anticoagulants
C. Antimuscarinics
D. alpha adrenergic

A

C. Antimuscarinics-

48
Q

Q. Why do we need to watch our COPD patients that we use diuretics on?
A. hypotension
B. reduced blood return to the heart
C. NKCC receptor malfunction leading to hypernatremia
D. Metabolic alkalosis can depress the respiratory drive leading to hypercarbia

A

D. Metabolic alkalosis can depress the respiratory drive leading to hypercarbia-

49
Q

Q. Most effective way to reduce pulmonary hypertension in COPD?
A. Lung evacuation maneuver
B. O2 supplementation
C. Intubation
D. aerobic exercise

A

B. O2 supplementation-

50
Q

Q. In patients with refractory COPD, what can be performed to improve symptoms?
A. Lung reduction surgery
B. Lung transplant
C. Right Lung Removal
D. Lung Pump insertion

A

A. Lung reduction surgery-

51
Q

Q. What portion of the heart are we most concerned regarding COPD?
A. Right Atrium
B. Right Ventricle
C. Left atrium
D. Left ventricle

A

B. Right Ventricle-

52
Q

Q. Effective therapies post op to prevent complications in COPD and most patients? (select all that apply)
A. CPT-
B. Incentive spirometry-
C. Deep breathing-
D. Coughing-

A

A. CPT-
B. Incentive spirometry-
C. Deep breathing-
D. Coughing-

53
Q

Q. What is the best advice we can give to our asthmatics and COPD patients regarding education w/ associated improved outcomes?
A. Smoking cessation
B. personal exercise program
C. motivational posters
D. David goggin’s quotes

A

A. Smoking cessation-

54
Q

Q. What is the E ½ of Carbon monoxide?
A. 2 hours
B. 15 hours
C. 12 hours
D. 5 hours

A

D. 5 hours-

55
Q

Q. What might we see with recent nicotine ingestion? (select all)
A. SNS activation
B. tweaking out
C. alertness
D. anxiolysis

A

A. SNS activation-
C. alertness-

56
Q

Q. Findings found 12 hours post cigarette smoke exposure (select all)
A. CO levels of 6%
B. P50 of 20 mmHg
C. Increased P50
D. CO levels of 1%

A

C. Increased P50
D. CO levels of 1%

57
Q

Q. Your patient has not had a cigarette in two days, what complications will the CRNA have to be prepared for? (select all)
A. Thick sputum
B. Reactive small airways
C. decreased lung volumes
D. retained ETT

A

A. Thick sputum-
B. Reactive small airways-

58
Q

Q. It takes about two months for these to return to normal function s/p smoking cessation?
A. breath holding capabilities
B. immune function
C. hepatic enzyme capabilities
D. lung volumes

A

B. immune function-
C. hepatic enzyme capabilities -

59
Q

Q. If your patient wants to stop smoking, what is a good time frame to stop pre surgergy?
A. 1-2 weeks
B. 6-8 weeks
C. 4-6 weeks
D. 8-10 weeks

A

B. 6-8 weeks-

60
Q

Q. This is defined a chronic airway dilation and persistent infection
A. Bronchitis
B. Bronchial paralysis
C. Bronhchoscopitis
D. Bronchiectasis

A

D. Bronchiectasis -

61
Q

Q. Bronchiectasis diagnosis gold standard?
A. XRAY
B. CBC
C. MRI
D. CT

A

D. CT-

62
Q

Q. The result of chronic infection leads to this disease process that is caused by a gene mutation ?
A. pleuritis
B. COPD
C. cystic fibrosis
D. emphysema

A

C. cystic fibrosis-

63
Q

Q. What ion is suspected to be responsible in cystic fibrosis
A. Mg++
B. K+
C. I-
D. Cl-

A

D. Cl- -

64
Q

Q. Why is a malfunction in the chloride channel such a problem for cystic fibrosis patients? (select all)
A. severe organ damage
B. Thick and unclearable sputum
C. malabsorption of fats & fat-soluble vitamins
D. chronic pulmonary infection

A

A. severe organ damage-
B. Thick and unclearable sputum-
C. malabsorption of fats & fat-soluble vitamins-
D. chronic pulmonary infection-

65
Q

Q. CF gold standard confirmation, typically done on infants?
A. chloride concentration >40mEq/L
B. chloride concentration >60 mEq/L
C. chloride concentration >50mEq/L
D. chloride concentration > 20mEq/L

A

B. chloride concentration >60 mEq/L-

66
Q

Q. This is what CF patients need to do daily to maintain airway function?
A. aggressive exercise
B. incentive spirometry
C. high frequency chest PT
D. postural drainage

A

C. high frequency chest PT-
D. postural drainage-

67
Q

Q. What do CRNAs want to see prior to extubation in our CF patients?
A. normal TVs
B. adequate RRs
C. Reflexes
D. prolonged expiratory flows

A

A. normal TVs-
B. adequate RRs-
C. Reflexes-

68
Q

Q. What vitamin might our CF patients need?
A. K
B. B12
C. C
D. D

A

A. K-

69
Q

Q. Triad of chronic sinusitis, bronchiectasis, and situs inversus are associated with what syndrome
A. Kartzinger
B. Kartagener
C. Kolgenholff
D. Kopenhagen

A

B. Kartagener-

70
Q

Q. If your patient has Kartagener syndrome, what impaired function are you likely to find?
A. ciliary dyskinesia
B. poor lung volumes
C. hyperreactive airways
D. hypoxemia

A

A. ciliary dyskinesia-

71
Q

Q. Besides the epithelial cell types, what other cilia are in dysfunction in ciliary dyskinesia
A. neurons
B. squamous
C. cuboidal
D. sperm

A

D. Sperm

72
Q

Q. Impaired ciliary activity leads to? (select all)
A. chronic sinusitis
B. recurrent respiratory infections
C. bronchiectasis
D. hypercarbia

A

A. chronic sinusitis-
B. recurrent respiratory infections-
C. bronchiectasis-

73
Q

Q. What is reversed in dextrocardia?
A. ABG
B. CBC
C. EKG
D. PFT

A

C. EKG-

74
Q

Q. Since we know most patients with ciliary dyskinesia have situs inversus, where would I place my IJ CVC?
A. Left subclavian
B. LEFT IJ
C. RIGHT IJ
D. RIGHT Subclavian

A

B. LEFT IJ-

75
Q

Q. What leads to Bronchiolitis Obliterans? (select all)
A. epithelial inflammation
B. pneumonitis
C. subepithelial inflammation
D. myocarditis

A

A. epithelial inflammation-

C. subepithelial inflammation-

76
Q

Q. When are we worried about tracheal stenosis?
A. < 6 mm
B. < 5 mm
C. <10 mm
D. < 15 mm

A

B. < 5 mm-

77
Q

Q. A flow volume loop typical of a central airway obstruction, would present how? (select all)
A. . Accessory muscles are utilized
B. Flat inspiratory flow
C. Flat expiratory flow
D. stridor

A

A. . Accessory muscles are utilized-
B. Flat inspiratory flow-
C. Flat expiratory flow-
D. stridor-

78
Q

What is the estimated annual incidence rate of the common cold in individuals aged 45-65 years?

A) 5%
B) 16%
C) 19%
D) 95%

A

B) 16%

79
Q

Infectious nasopharyngitis is predominantly caused by which type of pathogen?

A) Bacteria
B) Viruses
C) Fungi
D) Parasites

A

Correct Answer: B) Viruses

Rationale:
Infectious nasopharyngitis, contributing to approximately 95% of all acute upper respiratory tract infections (URIs), is primarily viral in origin. This question evaluates the understanding of the etiological agents behind URIs, with rhinovirus, coronavirus, influenza, parainfluenza, and respiratory syncytial virus (RSV) being the most common pathogens, as indicated indirectly by the slide.

Tex Wes Semester 2 Savage (13 decks)

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