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Assessment Exam 4 > Obstructive Lung Disease '24 > Flashcards

Obstructive Lung Disease '24 Flashcards

1
Q

What do obstructive respiratory diseases contribute to in the perioperative setting?

A

Risk of pulmonary complications

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2
Q

What role do pulmonary complications play in long-term postoperative mortality?

A

Major role

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3
Q

How can the incidence of perioperative pulmonary complications be decreased?

A

Pt optimization before surgery

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4
Q

How can obstructive respiratory diseases be classified in terms of anesthetic management?

A

4 groups

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5
Q

What percentage of people aged 25-44 experience the common cold per year?

A

19%

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6
Q

Delete card. What fraction of scheduled surgery patients may have an active URI?

A

Consequently, a fraction

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7
Q

What accounts for approximately 95% of all URIs?

A

Infectious nasopharyngitis

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8
Q

What are the most common viral pathogens associated with URIs?

A

Rhinovirus, coronavirus, influenza, parainfluenza, RSV

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9
Q

Why are viral cultures and lab tests impractical in a busy clinical setting for diagnosing URI?

A

Lack sensitivity, time-consuming, expensive

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10
Q

What are some respiratory adverse events children with URI’s are at a higher risk for?

A

Transient hypoxemia, laryngospasm, breath holding, coughing

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11
Q

Is data on how adults with URI’s fare under anesthesia readily available?

A

Limited data

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12
Q

How long should surgery be postponed if cancelled due to an acute URI?

A

Not be rescheduled within 6 weeks

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13
Q

What does the COLDS scoring system assess in relation to proceeding with surgery?

A

Current symptoms, onset, lung disease, airway device, type of surgery

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14
Q

What should be included in the anesthetic management of patients with upper respiratory infections (URIs)?

A

Adequate hydration, reducing secretions, limiting airway manipulation

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15
Q

How can upper airway sensitivity be reduced in patients with URIs?

A

Nebulized or topical local anesthetic on vocal cords

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16
Q

Which airway device may reduce the risk of laryngospasm in patients with URIs?

A

LMA (laryngeal mask airway)

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17
Q

What is a consideration for induction and maintenance in patients with URIs?

A

Similar to asthma

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18
Q

When may deep extubation be considered in patients with URIs?

A

No contraindications, for smoother emergence

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19
Q

What adverse respiratory events can occur in patients with URIs?

A

Bronchospasm, laryngospasm, airway obstruction, postintubation croup, desaturation, atelectasis

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20
Q

How can intraoperative and postoperative hypoxemia be treated in patients with URIs?

A

Supplemental O2

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21
Q

What is asthma?

A

Chronic inflammation of lower airways

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22
Q

What leads to infiltration of airway mucosa in asthma?

A

Activation of inflammatory cascade

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23
Q

What results in airway edema in asthma?

A

Inflammation

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24
Q

What leads to thickening of basement membrane and smooth muscle mass in asthma?

A

Airway remodeling

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25
Q

What are the main inflammatory mediators implicated in asthma?

A

Histamine, prostaglandin D2, leukotrienes

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26
Q

What are some symptoms of asthma?

A

Expiratory wheezing, cough, dyspnea, chest tightness, eosinophilia

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27
Q

What is status asthmaticus?

A

Life-threatening bronchospasm

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28
Q

What should be focused on when obtaining history from an asthma patient?

A

Previous intubations, ICU admissions, hospitalizations, coexisting diseases

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29
Q

How is asthma diagnosed?

A

Clinical history, symptoms, airway obstruction

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30
Q

What symptoms are reported by patients with asthma?

A

Wheezing, chest tightness, SOB

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31
Q

How is asthma severity classified?

A

Symptoms, PFTs, medication usage

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32
Q

What is Forced Expiratory Volume in 1 sec (FEV1)?

A

Volume of air exhaled in 1 sec

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33
Q

What is the normal range for FEV1?

A

80%-120% of predicted value

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34
Q

What is Forced Vital Capacity (FVC)?

A

Volume exhaled after deep inhalation

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35
Q

What are the normal FVC values for females and males?

A

3.7 L (females) and = 4.8 L (males)

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36
Q

What is the normal range for the FEV1/FVC ratio in healthy adults?

A

75%-80%

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37
Q

What is Maximum Voluntary Ventilation (MVV)?

A

Max air in/out in 1 min

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38
Q

How is MVV measured?

A

Over 15 sec extrapolated

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39
Q

What are the average MVV values for males and females?

A

140-180 L/min, 80-120 L/min

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40
Q

What is Diffusing Capacity (DLCO)?

A

CO transfer to blood

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41
Q

How is DLCO measured?

A

CO breath held 20 sec

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42
Q

What is the normal DLCO value?

A

17-25 mL/min/mm Hg

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43
Q

What are direct measures of the severity of expiratory obstruction in asthma?

A

FEV1, FEF, midexpiratory phase flow

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44
Q

What is a typical FEV1 percentage in a symptomatic asthmatic patient coming to the hospital?

A

<35%

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45
Q

What do flow-volume loops show in asthma?

A

Downward scooping of expiratory limb

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46
Q

What happens to the functional residual capacity (FRC) during moderate or severe asthma attacks?

A

May increase substantially

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47
Q

What happens to total lung capacity (TLC) during moderate or severe asthma attacks?

A

Usually remains normal

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48
Q

What is not changed in asthma patients regarding lung capacity for carbon monoxide?

A

Diffusing lung capacity

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49
Q

What does relief of obstruction after a bronchodilator suggest in patients with expiratory obstruction?

A

Diagnosis of asthma

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50
Q

Do abnormalities in pulmonary function tests (PFTs) persist after an asthma attack despite the absence of symptoms?

A

Yes

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51
Q

What is B in FEV1 <80% of VC?

A

bronchospasm

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52
Q

Inspiratory flow normal

A

Volume increasing

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53
Q

Restrictive (expiratory)

A

R(E)

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54
Q

Restrictive (parenchymal)

A

R(P)

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55
Q

Normal flow-volume curve of expiration

A

TLC to RV

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56
Q

What ABG findings are common in symptomatic asthma?

A

Hypocarbia and respiratory alkalosis

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57
Q

What may result in a PaO2 of <60 mmHg in asthma?

A

Increasing severity of expiratory obstruction

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58
Q

When does PaCO2 likely increase in asthma?

A

When FEV1 is <25% of predicted

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59
Q

What contributes to the development of hypercarbia in asthma?

A

Fatigue of skeletal muscles

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60
Q

What findings may be seen in the CXR of patients with severe asthma?

A

Hyperinflation, hilar vascular congestion

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61
Q

How can CXRs be helpful in asthma exacerbations?

A

Determining cause, ruling out other causes

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62
Q

What EKG findings may be present during an asthma attack?

A

RV strain, ventricular irritability

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63
Q

What are some differential diagnoses for asthma?

A

Viral tracheobronchitis, sarcoidosis, COPD, foreign body aspiration

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64
Q

What is the aim of asthma treatments?

A

Control symptoms and reduce exacerbations

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65
Q

What is the first-line treatment for patients with mild asthma?

A

Short-acting inhaled β2 agonist

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66
Q

What is recommended for those with less than 2 exacerbations per month?

A

Short-acting inhaled β2 agonist

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67
Q

What can be added if symptoms remain uncontrolled despite initial treatment?

A

Daily inhaled β2 agonist

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68
Q

What other therapies can be considered for asthma treatment?

A

Inhaled muscarinic antagonists, leukotriene modifiers, mast cell stabilizers

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69
Q

When are systemic corticosteroids used in asthma treatment?

A

Severe asthma uncontrolled with inhalational medications

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70
Q

What does SQ immunotherapy show in asthma treatment studies?

A

Decreases long-term medication use, may improve quality of life

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71
Q

What is bronchial thermoplasty (BT)?

A

Radiofrequency ablation of airway smooth muscles

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72
Q

How is bronchial thermoplasty (BT) performed?

A

Through bronchoscopy in three sessions

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73
Q

What can be a risk of bronchial thermoplasty (BT)?

A

Airway fire due to intense heat

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74
Q

How does the loss of airway smooth muscle mass help in asthma treatment?

A

Reduces bronchoconstriction

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75
Q

Why are serial PFTs important during treatment?

A

To monitor response

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76
Q

At what % of normal FEV1 do patients usually have minimal or no symptoms?

A

50%

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77
Q

What is acute severe asthma defined as?

A

Bronchospasm not resolving with usual treatment

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78
Q

Why is acute severe asthma considered life-threatening?

A

Emergency situation

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79
Q

What is the emergency treatment for acute severe asthma?

A

High-dose, short-acting β2 agonists and systemic corticosteroids

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80
Q

How often can inhaled β2 agonists be administered in acute severe asthma?

A

Every 15-20 minutes for several doses

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81
Q

Why are IV corticosteroids administered early in acute severe asthma?

A

Onset takes several hours

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82
Q

What are the two corticosteroids commonly used in acute severe asthma?

A

Hydrocortisone & methylprednisolone

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83
Q

Why is supplemental oxygen given in acute severe asthma?

A

To maintain oxygen saturation >90%

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84
Q

What other drugs can be used in more severe cases of acute severe asthma?

A

Magnesium and oral leukotriene inhibitors

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85
Q

What is the recommended oxygen saturation level to maintain in acute severe asthma?

A

> 90%

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86
Q

What is the interval for administering 2 agonists via metered-dose inhaler or continuous nebulizer in acute severe asthma?

A

every 15-20 min

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87
Q

What type of corticosteroids are recommended for intravenous administration in acute severe asthma?

A

hydrocortisone or methylprednisolone

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88
Q

When is tracheal intubation and mechanical ventilation recommended in acute severe asthma?

A

when Paco₂ >50 mm Hg

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89
Q

What medication can be administered by inhalation as an anticholinergic in acute severe asthma?

A

ipratropium

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90
Q

What can be considered as a last resort in acute severe asthma?

A

Extracorporeal membrane oxygenation (ECMO)

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91
Q

What is the purpose of high gas flows in mechanical ventilation for acute severe asthma?

A

permit short inspiration times and longer expiration times

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92
Q

Percentage range of asthmatics experiencing bronchospasm under GA

A

0.2-4.2%

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93
Q

Factors increasing risk of bronchospasm in asthmatics

A

Type of surgery, recency of last asthma attack

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94
Q

GA mechanisms increasing airway resistance

A

Depression of reflexes/functions, increased fluid in airway wall

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95
Q

Roll of intubation in asthma patients under GA

A

Stimulates airway, contributing to bronchospasm

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96
Q

Substances contributing to bronchospasm in asthmatics under GA

A

Substance P, neurokinins

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97
Q

What does preoperative evaluation of patients with asthma involve?

A

Disease severity, current treatment effectiveness, need for additional therapy

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98
Q

What aspects of a patient’s history should be noted in preoperative assessment of asthma?

A

Symptom control, exacerbation frequency, hospitalizations, anesthesia tolerance

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99
Q

Why is auscultation of the chest important in asthma preoperative assessment?

A

To detect wheezing or crepitations

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100
Q

What do eosinophil counts often reflect in asthma management?

A

Degree of airway inflammation

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101
Q

What pulmonary function tests may be indicated in preoperative assessment of asthma?

A

(esp FEV1) before and after bronchodilator

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102
Q

What reduction in FEV1 or FVC poses a risk for perioperative respiratory complications?

A

<70% of predicted, or FEV1:FVC ratio <65% of predicted

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103
Q

How can reversible components of asthma be improved preoperatively?

A

Chest physiotherapy, antibiotics, bronchodilators

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104
Q

When are ABGs indicated in preoperative assessment for asthma?

A

If there is a question about ventilation or oxygenation

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105
Q

What medications should be continued until induction in a preoperative asthma assessment?

A

Anti-inflammatories, bronchodilators

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106
Q

What is indicated if the patient has been on systemic corticosteroids within the past 6 months?

A

Stress-dose hydrocortisone or methylprednisolone

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107
Q

What criteria should be met regarding wheezing and PEFR before surgery in asthma patients?

A

Free of wheezing, PEFR >80% predicted/personal best value

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108
Q

What is COPD?

A

Chronic airflow obstruction

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109
Q

What are the symptoms of emphysema in COPD?

A

Lung parenchymal destruction

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110
Q

What risks factors contribute to COPD?

A

Cigarette smoking, dust exposure, genetic factors

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111
Q

What is the worldwide prevalence of COPD?

A

10%

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112
Q

How does COPD rank among causes of death globally?

A

3rd leading cause of death

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113
Q

What is one of the pathologic effects of COPD?

A

Destruction of lung parenchyma, enlarged air sacs, and development of emphysema

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114
Q

How does COPD impact bronchiolar wall structure?

A

Decreases structure, allowing collapse during exhalation

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115
Q

What happens to intrabronchial pressure in COPD?

A

Lowers and favors airway collapse

116
Q

What are the symptoms of COPD?

A

Dyspnea, chronic cough, chronic sputum

117
Q

What characterizes COPD exacerbations?

A

Acute worsening in airflow obstructions

118
Q

How do tachypnea and prolonged expiratory times manifest as COPD worsens?

A

Evident with increasing expiratory obstruction

119
Q

What are common breath sounds in COPD?

A

Decreased sounds, expiratory wheezes

120
Q

What triggers exacerbations in COPD as the disease progresses?

A

Bacterial respiratory infections

121
Q

How is the definitive diagnosis of COPD made?

A

Spirometry

122
Q

What do PFTs show in patients with COPD?

A

Decrease in FEV1:FVC ratio and FEF 25-75%

123
Q

What are common findings in COPD?

A

FEV1:FVC <70%, increased FRC & TLC, reduced DLCO

124
Q

Why is there an increase in residual volume in COPD?

A

Slow expiratory airflow and gas trapping

125
Q

What does the compensated increase in RV and FRC in COPD lead to?

A

Enlarged airway diameter

126
Q

GOLD Spirometric Criteria for Mild COPD Severity

A

FEV1 ≥ 80% predicted

127
Q

GOLD Spirometric Criteria for Moderate COPD Severity

A

50% ≤ FEV1 < 80% predicted

128
Q

GOLD Spirometric Criteria for Severe COPD Severity

A

30% ≤ FEV1 < 50% predicted

129
Q

GOLD Spirometric Criteria for Very Severe COPD Severity

A

FEV1 < 30% predicted

130
Q

What imaging technique is much more sensitive at diagnosing COPD than CXR?

A

CT

131
Q

What does hyperlucency in the lung periphery suggest in COPD diagnosis?

A

Emphysema

132
Q

What confirms emphysema in COPD diagnosis?

A

Bullae

133
Q

What is the multiorgan loss of tissue phenotype of COPD associated with?

A

Airspace enlargement, alveolar destruction, loss of bone, muscle, and fat tissues, higher rates of lung cancer

134
Q

What is the bronchitic phenotype of COPD associated with?

A

Bronchiolar narrowing, wall thickening, metabolic syndrome, cardiac disease

135
Q

What is the BODE index used for in COPD diagnosis?

A

Assess prognosis

136
Q

What do higher BODE scores indicate?

A

Greater risk of exacerbations, hospitalizations, and pulmonary death

137
Q

What does α1-antitrypsin deficiency associate with in COPD?

A

Inherited disorder

138
Q

What is required for low α1-antitrypsin levels in COPD?

A

Lifelong replacement therapy

139
Q

What should be measured in COPD patients with uncontrolled disease despite bronchodilator treatment?

A

Eosinophils

140
Q

What does high eosinophil levels indicate the need for in COPD treatment?

A

Inhaled glucocorticoids

141
Q

When do ABGs in COPD patients often remain normal?

A

Until COPD is severe

142
Q

When does PaO2 usually decrease in relation to FEV1 in COPD?

A

When FEV1 is <50% of predicted

143
Q

When may PaCO2 not increase significantly in COPD?

A

Until FEV1 is even lower

144
Q

What is the first step in COPD treatment?

A

Reducing exposure to smoke and environmental pollutants

145
Q

How much can smoking cessation decrease disease progression and mortality by?

A

Up to 18%

146
Q

What is the initial treatment in COPD?

A

Long-acting inhaled muscarinic antagonists

147
Q

What can be added if dyspnea persists despite initial treatment?

A

Long-acting β2 agonist

148
Q

When are inhaled glucocorticoids most effective in COPD patients?

A

Associated asthma, rhinitis, elevated eosinophils, and history of exacerbations

149
Q

What can inhaled treatments improve in COPD?

A

Symptoms, FEV1

150
Q

What are other treatments recommended for COPD?

A

Flu & pneumonia vaccines

151
Q

What are helpful for COPD if right heart failure (RHF) or congestive heart failure (CHF) develop?

A

Diuretics

152
Q

What treatments may be necessary during COPD exacerbations?

A

Abx, corticosteroids, theophylline

153
Q

What can pulmonary rehab programs do for individuals with COPD?

A

Increase exercise capacity

154
Q

When is long-term home oxygen recommended in COPD treatment?

A

PaO2 <55mmHg, HCT >55%, evidence of cor-pulmonale

155
Q

What is the goal PaO2 with supplemental oxygen in COPD treatment?

A

> 60 mmHg

156
Q

How can supplemental O2 flow rate be titrated in COPD treatment?

A

According to ABG or SpO2

157
Q

Why is supplemental O2 more effective than drug therapy in COPD treatment?

A

Decreases pulmonary vascular resistance, pulmonary hypertension, prevents erythrocytosis

158
Q

What non-pharmacological interventions should be advised for COPD patients?

A

Deep breathing exercises or incentive spirometry

159
Q

What is the capital of France?

A

Paris

160
Q

What is the largest planet in our solar system?

A

Jupiter

161
Q

What is lung volume reduction surgery indicated for in COPD patients?

A

severe refractory COPD and overdistended lung tissue

162
Q

How does lung volume reduction surgery improve lung function?

A

increases elastic recoil, decreases hyperinflation, decreases ventilation/perfusion mismatch

163
Q

What are the common surgical approaches for lung volume reduction surgery?

A

median sternotomy or video-assisted thoracoscopic surgery (VATS)

164
Q

What is the recommended anesthesia management for lung-volume reduction surgery?

A

double-lumen ETT, avoidance of nitrous oxide, minimize excessive airway pressure

165
Q

Why is CVP an unreliable guide for fluid management during lung-volume reduction surgery?

A

surgical alterations affecting intrathoracic pressures

166
Q

What should be investigated in the history of a patient with COPD?

A

Causes, course, severity

167
Q

Why is it important to note the patient’s smoking history and current medications?

A

Impact on anesthesia management

168
Q

What should be determined regarding previous ventilation support in COPD patients?

A

Need for NIPPV or mechanical ventilation

169
Q

Why should patients with COPD be questioned about comorbidities?

A

Association with smoking & COPD

170
Q

How should right ventricular function be assessed in patients with pulmonary disease?

A

Clinical exam, echocardiogram

171
Q

What preoperative therapies should be continued until the morning of surgery for COPD patients?

A

Inhalation therapies

172
Q

How can postoperative pulmonary complications be reduced in COPD patients?

A

Chest physiotherapy

173
Q

Which clinical findings are more predictive of pulmonary complications in COPD patients?

A

Smoking, wheezing, productive cough

174
Q

Is the value of routine preoperative PFTs accepted in COPD patients?

A

Controversial

175
Q

What are some indications for preoperative pulmonary evaluation?

A

Hypoxemia on room air, history of respiratory failure, planned pneumonectomy

176
Q

What can be a sign of the need for preop pulmonary evaluation?

A

Severe shortness of breath from respiratory disease

177
Q

Do patients with COPD undergoing peripheral surgery need preop PFTs?

A

No

178
Q

What can be sufficient to assess lung disease if in doubt?

A

Spirometry with FEV1

179
Q

What can be assessed by measuring airflow related to lung volume?

A

Ventilatory function

180
Q

What is produced by plotting expiratory flow rates against lung volumes?

A

Flow-volume curves

181
Q

What are flow-volume loops obtained from?

A

Adding flow rates during inspiration to flow-volume curves

182
Q

When is the flow rate zero in relation to lung capacity?

A

At TLC before the start of expiration

183
Q

When is the peak flow rate achieved during expiration?

A

Rapidly after forced expiration begins

184
Q

How does the flow rate change as volume decreases to RV?

A

Falls in a linear fashion

185
Q

What causes a U shaped inspiratory curve during maximal inspiration from RV to TLC?

A

Most rapid inspiratory flow at midpoint of inspiration

186
Q

In COPD, what is observed in terms of expiratory flow rate at any given lung volume?

A

Lower expiratory flow rate

187
Q

What shape is the expiratory curve in COPD due to uniform emptying of the airways?

A

Concave

188
Q

Why is RV increased in COPD?

A

Air trapping

189
Q

What are some major patient-related risk factors for the development of postoperative pulmonary complications?

A

Age >60 yr, ASA class >II, CHF, Preexisting pulmonary disease, Cigarette smoking

190
Q

What are some procedure-related risk factors for the development of postoperative pulmonary complications?

A

Emergency surgery, Abdominal/thoracic/head and neck/neurovascular/aortic aneurysm surgery, Prolonged anesthesia, General anesthesia

191
Q

What test predictor is associated with an increased risk of postoperative pulmonary complications?

A

Albumin level <3.5 g/dL

192
Q

What strategies should be encouraged preoperatively to reduce post-op complications?

A

Smoking cessation, treat airflow obstruction and respiratory infection, initiate patient education on lung volume expansion maneuvers.

193
Q

What intraoperative strategies can help reduce post-op complications?

A

Minimally invasive surgery, regional anesthesia, avoid lengthy procedures.

194
Q

What postoperative interventions are recommended to reduce complications?

A

Lung volume expansion maneuvers, maximize analgesia.

195
Q

What percentage of smokers undergo general anesthesia annually?

A

5-10%

196
Q

When is the maximum benefit of smoking cessation seen in relation to surgery?

A

at least 8 weeks prior

197
Q

What is the single-most important risk factor for developing COPD and death caused by lung disease?

A

Smoking

198
Q

What does the American Society of Anesthesiologists provide to help encourage smoking cessation?

A

resources

199
Q

How long do the sympathomimetic effects of nicotine on the heart last?

A

20-30 minutes

200
Q

What is the elimination half-life of carbon monoxide?

A

4-6 hrs

201
Q

Within 12 hours of smoking cessation, how much does P50 increase from?

A

22.9 to 26.4 mmHg

202
Q

What happens to plasma levels of carboxyhemoglobin 12 hours after smoking cessation?

A

decrease from 6.5% to 1%

203
Q

Does short-term abstinence from cigarettes decrease postop pulmonary complications?

A

No

204
Q

How long does it take to see improved ciliary and small airway function after quitting smoking?

A

Weeks

205
Q

What effect does smoking have on immune responses and response to pulmonary infection following surgery?

A

Interfere

206
Q

How long does it take for normal immune function to return after quitting smoking?

A

At least 6 weeks

207
Q

How long may it take for hepatic enzyme activity to return to normal after quitting smoking?

A

6 weeks or longer

208
Q

What is the optimal timing of smoking cessation before surgery to reduce postop pulmonary complications?

A

6-8 weeks

209
Q

What interventions should be offered to smokers scheduled for surgery in less than 4 weeks?

A

Behavioral support, pharmacotherapy

210
Q

What are some options for nicotine replacement therapy?

A

Patches, inhalers, nasal sprays, lozenges, gum

211
Q

When should sustained release bupropion be started in relation to smoking cessation?

A

1-2 weeks before

212
Q

What are some disadvantages that can be experienced in the immediate preop period due to smoking cessation?

A

Sputum production, stress handling issues, withdrawal symptoms

213
Q

What is bronchiectasis associated with?

A

Irreversible airway dilation, inflammation, chronic bacterial infection

214
Q

Who is the prevalence of bronchiectasis highest in?

A

Pts >60 with chronic pulmonary dz and in women

215
Q

What are the symptoms of bronchiectasis?

A

Chronic productive cough, purulent sputum, hemoptysis, clubbing

216
Q

What leads to a vicious cycle in bronchiectasis?

A

Poor mucociliary activity and mucous pooling

217
Q

Why is it nearly impossible to eradicate bacterial superinfection in bronchiectasis?

A

Recurrent bacterial infections causing further inflammation

218
Q

What baseline tests should be obtained for all suspected patients of bronchiectasis?

A

CXR and PFT

219
Q

What does CT usually show in bronchiectasis?

A

Dilated bronchi

220
Q

What are key treatments for bronchiectasis?

A

Abx and chest physiotherapy

221
Q

What guides antibiotic selection in bronchiectasis?

A

Results of sputum cultures

222
Q

When is surgery considered in bronchiectasis?

A

Severe symptoms persist or recurrent complications occur

223
Q

What is cystic fibrosis?

A

Autosomal recessive disorder of chloride channels

224
Q

How many people does cystic fibrosis affect in the US?

A

30,000

225
Q

What gene mutation causes cystic fibrosis?

A

Gene on chromosome 7 encoding CFTR

226
Q

How does mutated CFTR gene affect mucus production?

A

Abnormally thick mucus

227
Q

What is the primary cause of morbidity and mortality in cystic fibrosis?

A

Chronic pulmonary infection

228
Q

What can the end result of cystic fibrosis lead to?

A

Severe organ damage

229
Q

What are the diagnostic criteria for cystic fibrosis?

A

Sweat chloride concentration >60 mEq/L with clinical sx or family history

230
Q

How can DNA analysis contribute to diagnosing cystic fibrosis?

A

Identifies >90% of pts with CFTR mutation

231
Q

What is almost universal in individuals with cystic fibrosis?

A

Chronic pansinusitis

232
Q

What type of evidence indicates pancreatic exocrine insufficiency associated with cystic fibrosis?

A

Malabsorption with response to pancreatic enzyme tx

233
Q

What is a sign of airway inflammation seen in bronchoalveolar lavage of cystic fibrosis patients?

A

High percentage of neutrophils

234
Q

What condition is virtually present in all adult cystic fibrosis patients?

A

COPD

235
Q

What is a potential treatment for cystic fibrosis that is currently being investigated?

A

Gene therapy

236
Q

What is the main nonpharmacologic approach to enhancing clearance of secretions in cystic fibrosis?

A

Chest physiotherapy with postural drainage

237
Q

What is a possible alternative method of physiotherapy for cystic fibrosis patients?

A

High-frequency chest compression with an inflatable vest and airway oscillation devices

238
Q

When can bronchodilators be considered for cystic fibrosis patients?

A

If pts have a beneficial response to inhaled bronchodilators

239
Q

How is a beneficial response to bronchodilators defined in cystic fibrosis patients?

A

Increase of 10% or more in FEV1 after administration

240
Q

What contributes to the thick viscosity of secretions in cystic fibrosis?

A

Neutrophils and degradation products

241
Q

How can DNA released from neutrophils be cleaved to increase sputum clearance in CF?

A

Recombinant human deoxyribonuclease

242
Q

How are antibiotics selected for patients with CF?

A

Based on identification of bacteria from sputum cultures

243
Q

When bronchoscopy may be indicated for CF patients with no pathogens identified in sputum cultures?

A

To remove lower airway secretions

244
Q

What is often prescribed for many cystic fibrosis patients to suppress chronic infection?

A

Long-term maintenance antibiotics

245
Q

When should elective surgery be delayed in relation to pulmonary function?

A

Until optimal pulmonary function is ensured by controlling infection and facilitating removal of airway secretions

246
Q

In what situations may Vitamin K be necessary for anesthesia?

A

If hepatic function is poor or exocrine pancreatic function is impaired

247
Q

What are important steps in maintaining less-viscous secretions during anesthesia?

A

Humidification of inspired gases, hydration, and avoidance of anticholinergic drugs

248
Q

When may frequent tracheal suctioning be necessary during anesthesia?

A

Maintaining less-viscous secretions

249
Q

What conditions should patients meet before extubation?

A

Regain full airway reflexes, adequate TV & RR

250
Q

Why is postop pain control important during anesthesia recovery?

A

To allow for deep breathing, coughing, and early ambulation to minimize pulmonary complications

251
Q

What is Primary Ciliary Dyskinesia?

A

Impaired ciliary activity in respiratory tract and other areas

252
Q

What are the consequences of impaired ciliary activity in Primary Ciliary Dyskinesia?

A

Chronic sinusitis, recurrent respiratory infections, bronchiectasis, infertility

253
Q

What is Kartagener syndrome?

A

Chronic sinusitis, bronchiectasis, situs inversus

254
Q

What is the association between cilia function and situs inversus?

A

Approximately half exhibit situs inversus

255
Q

What is the association between isolated dextrocardia and congenital heart disease?

A

Almost always associated

256
Q

What is the preferred vein for central venous catheterization in the presence of significant organ inversion?

A

Left IJ vein preferred due to inversion of the great vessels

257
Q

How should uterine displacement be done in pregnant women?

A

Displacement to the right side

258
Q

What is implemented to avoid vena cava syndrome in pregnant women?

A

Left uterine displacement (LUD)

259
Q

What is the reason for selecting the right internal jugular vein for CVC insertion in typical cases?

A

Right IJ leads straight to the SVC

260
Q

Why may a left double-lumen endotracheal tube be preferred over a right one?

A

RUL more easily obstructed in cases of pulmonary inversion

261
Q

What positioning adjustments are needed for EKG interpretation in the presence of dextrocardia?

A

Reverse placement for accurate interpretation

262
Q

How can postoperative pulmonary complications be decreased in patients with Primary Ciliary Dyskinesia?

A

Regional anesthesia preferable to general anesthesia

263
Q

Why should nasopharyngeal airways be avoided in patients with Primary Ciliary Dyskinesia?

A

High incidence of sinusitis

264
Q

What is Bronchiolitis Obliterans?

A

Epithelial and subepithelial inflammation

265
Q

What are the risk factors for Bronchiolitis Obliterans?

A

Viral infections, environmental exposures, transplants

266
Q

What are the symptoms of Bronchiolitis Obliterans?

A

Dyspnea, nonproductive cough

267
Q

What do PFTs show in Bronchiolitis Obliterans?

A

Obstructive disease, reduced FEV1

268
Q

What finding on high-resolution CT indicates severe Bronchiolitis Obliterans?

A

Air trapping, bronchiectasis

269
Q

What does Central Airway Obstruction include?

A

Tracheal and mainstem bronchi obstruction

270
Q

What percentage of lung cancer patients can be affected by airflow obstruction?

A

20-30%

271
Q

What can cause central airway obstruction?

A

Tumors, chronic infection granulation, cartilage destruction

272
Q

What can develop after prolonged intubation with ETT or tracheostomy tube?

A

Tracheal stenosis

273
Q

How can tracheal mucosal ischemia progress?

A

To destruction of cartilaginous rings and scar formation

274
Q

How can the risk of tracheal mucosal ischemia be minimized?

A

Use high-volume, low-pressure cuffs on ETTs

275
Q

What diameter does tracheal stenosis become symptomatic?

A

<5mm

276
Q

When may symptoms of tracheal stenosis develop after extubation?

A

several weeks

277
Q

What symptom is prominent even at rest in central airway obstruction?

A

dyspnea

278
Q

What is usually audible in central airway obstruction?

A

stridor

279
Q

What do flow-volume loops typically show in central airway obstruction?

A

flattened curves

280
Q

What muscles are utilized throughout all phases of the breathing cycle in central airway obstruction?

A

accessory muscles

281
Q

What will a CT illustrate in central airway obstruction?

A

tracheal narrowing

282
Q

What can be used as a temporizing measure to treat tracheal stenosis?

A

Tracheal dilation

283
Q

What methods can be used for tracheal dilation in tracheal stenosis?

A

Balloon dilators, surgical dilators, laser resection

284
Q

What is considered the most successful treatment for tracheal stenosis?

A

Surgical resection & reconstruction with primary re-anastomosis

285
Q

What is necessary for the surgical procedure of tracheal resection and reconstruction?

A

Translaryngeal intubation

286
Q

What is useful for ensuring maximal FiO2 during maintenance of anesthesia for tracheal resection?

A

Volatile anesthetics

287
Q

What may be facilitated by the addition of helium to the inspired gases during anesthesia for tracheal resection?

A

Tracheal ventilation

Assessment Exam 4 (9 decks)

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