Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Health Assessment - Spring 2025 > Obstructive Lung Disease (Exam IV) Stephen's Cards > Flashcards

Obstructive Lung Disease (Exam IV) Stephen's Cards Flashcards

1
Q

What is obstructive sleep apnea?

A
  • Recurrent upper airway collapse during sleep
  • causes ↓ or complete cessation of airflow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What 3 things will polysomnography recordings show?

A
  • Apnea
  • Hypopnea
  • Respiratory effort-related arousals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the definition of apnea?

A
  • 90% ↓ in amplitude of airflow signal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are 3 classifications of apnea?
How long do the episodes have to last?

A
  • Obstructive
  • Central
  • Mixed
  • Duration of 10 seconds or more
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the definition of hypopnea?

A
  • ↓ of 30% or 50% or more in amplitude of nasal presure that last for 90% or more of the breath
  • ↓ 4% or more in SpO2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the Apnea-hypopnea index (AHI)

A

Number of apnea and hypopnea events per hour of sleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are respiratory effort-related arousals?

A
  • A limitation in the airflow followed by an arousal on the EEG channel. (Flattening of the airflow in a way that does not meet the criteria for apnea or hypopnea)
  • Duration of 10 seconds or more
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is sleep apnea or hypopnea diagnosed?

A
  • If AHI ≥ 15
  • If AHI ≥ 5 plus S/Sx or associated medical or psychiatric disorder such as HTN CAD CHF insomnia snoring etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is Obstructive sleep apnea syndrome (OSAS) diagnosed?

A
  • AHI ≥ 5
  • Daytime somnolence ≥ 2 days/week
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 3 severity levels of OSA?

A
  • Mild → AHI 5-15
  • Moderate → AHI 15-30
  • Severe → AHI ≥ 30
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the 3 direct physiologic mechanisms for Apnea/obstruction?

A
  • Anatomic and functional upper airway obstruction
  • ↓ respiratory-related EEG arousal response
  • Unstable ventilatory response to chemical stimuli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How are apnea episodes resolved by the body?

A
  • ↑ muscular activity at upper airway and thoracoabdominal respiratory muscles
  • EEG arousal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some of the neurocognitive consequence of OSA?

A
  • Slower EEG
  • Sleep deprivation
  • Sleepy in daytime
  • ↓ cognition performance
  • ↓ quality of life
  • ↑ car accidents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some of the metabolic consequences of OSA?

A
  • Hypoxic injury
  • inflammation
  • ↑ SNS activity
  • Hormonal changes
  • Insulin resistance / DM2
  • central obesity
  • Metabolic syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the most common sites of upper airway obstruction?

A

Retropalatal and retroglossal regions of the oropharynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some signs that a patient may have an issue with airway obstruction?

A
  • Bony craniofacial abnormalities
  • Excess soft tissue
  • Acromegaly thyroid enlargement and hypothyroidism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When will the airway collapse?

A
  • When the forces that can collapse airway > than forces the dilate the airway
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the collapsing forces of the airway?

A
  • intraluminal negative inspiratory pressure
  • extraluminal positive pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the dilating forces on the airway?

A
  • Pharyngeal dilating muscle tone
  • Longitudinal traction on upper airway d/t ↑ lung volume
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When the patient is ________ airway obstruction is enhanced?

A
  • Supine → supine enhances airway obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which patient position increases the effect of extraluminal positive pressure against the pharynx?

A

Supine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Altered neuromuscular control of the airway is related to what 2 things?

A
  • Inflammation
  • Denervation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Respiratory related arousal response is related to what 4 things?

A
  • Hypercapnia
  • Hypoxia
  • Upper airway obstruction
  • Work of breathing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are some clinical symptoms of OSA/apnea?

A
  • Day → dry mouth headache sleepy cognitive impairment
  • Night → wake up often snoring choking sensation breathing pauses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are some comorbidities associated with OSA?
* HTN * CAD * MI * HF * ESRD * Graves disease * DM2
26
What are some risk factors for OSA?
* elderly * Obesity * non-caucasian * male * pregnant * craniofacial abnormalities * smoking * narrow airway
27
What are some treatments for OSA?
* CPAP * oral appliances * Eletrical stim → stiimulates hypoglossal nerve (CN12) with every breath * Weight reduction * Surg
28
What are 4 surgeries that might help OSA?
* tonsillectomy * maxillomandibular advancement * ubulopalatopharyngoplasty * adenotonsillectomy
29
Risk for OSA increases by ___% for every 1 pt increase in ___________ score.
2.5% : Mallampati
30
During induction what are 4 things we can do to help reduce issues with OSA?
* elevate HOB * Pre oxygenate * Know they might be difficult to mask ventilate or intubate * Minimize or don't use opioids
31
What anesthetic type might be preferred for OSA patients?
Regional > GA
32
What are two mnemonics to help assess OSA?
**S**nore **T**ired **O**bserved **P**ressure **B**MI **A**ge **N**eck size **G**ender
33
What is the most common cause for acute URI?
* viral or bacterial nasopharyngitis (95% of cases)
34
What are 2 possible noninfectious causes of nasopharyngitis?
* Allergic * Vasomotor
35
What are some S/Sx of URI?
* nonproductive cough * sneezing * rhinorrhea
36
If a patient has had a URI that is not getting better how does that affect their surgery? What if it's getting better?
* Unstable → delay 6 weeks * Stable → proceed with surg
37
If the patient has had a recent URI what airway device might be preferred?
* LMA > ETT
38
What are some adverse respiratory events for a patient that had URI?
* bronchospasm * airway obstruction * postintubation croup * desat * atelectasis
39
What can we do to help ↓ risk r/t recent URIs when anesthetizing a patient?
* Hydrate * ↓ secretions * limit airway manipulation → URI causes hyperreactive airway * Nebulized or topical anesthetic to the vocal cords → URI causes hyperreactive airway * LMA > ETT
40
What is asthma?
* reversible airway obstruction * bronchial hyperreactivity * bronchoconstriction * chronic airway inflammation
41
What are some things that ↑ risk for asthma?
* Heriditary * Family Hx * mom smoked while pregnant * Limited childhood exposure to infectious environments
42
What is  status asthmaticus?
Life threatening bronchospasm that persists despite treatment
43
What are some things that can provoke an asthma attack?
* allergens * aspirin / β antagonists / NSAIDS * respiratory viruses * excercise → typ following exertion than during it * emotional stress
44
What is the pathogenesis of asthma?
* chronic inflammation in lower airways activates inflammatory cascade * Leads to bronchi and airway edema and thickened airways * Simultaneous areas of inlammation and repair in airways
45
In a patient with asthma, which inflammatory mediators infiltrate the airway mucosa?
* Eosinophils / neutrophils * mast cells * T-cells / B-cells * Leukotrienes
46
What are some S/Sx of asthma?
* wheezing * cough * dyspnea * chest tightness
47
How long can an asthma attack last?
* minutes to hrs
48
How can we determine if someone has severe asthma?
* prior intubation / ICU admission * ≥ 2 hospitalizations in a year * presence of coexisting disease
49
How is asthma diagnosed?
* S/S * Airflow obstruction on PFT that is partially reversible with bronchodilators
50
How is severity of Asthma diagnosed?
* clinical symptoms * PFTs * Med usage
51
What are some PFT changes we would see in an asthmatic?
* FEV1 < 35% of normal * Possible FRC increase
52
What are some ABG changes we might see with an asthmatic?
* hypocarbia * respiratory alkalosis
53
For mild asthma how will PaO2 and PaCO2 be affected on ABG?
* will be normal
54
For severe asthma how will PaO2 and PaCO2 be affected on ABG?
* PaO2 < 60 mmHg on RA * PaCO2 ↑ when the FEV1 < 25%
55
What changes on CXR will we see with an asthma patient?
* Mild/moderate → normal * Severe → hyperinflation and vascular congestion of hilum d/t mucous plugging and PHTN
56
What changes on ECG will be seen in an asthmatic?
* RV strain / irritability
57
What are 2 goals of treating asthma?
* Prevent / control bronchial inflammation * Treat bronchospasm
58
What are 2 SABA meds we talked about?
* Albuterol (Proventil) * levalbuterol (xopenex)
59
What are the 7 long term treatments for asthma we discussed in class?
* Inhaled corticosteroids → budesonide fluticasone * LABA → arformeterol (brovana) * Combo steriods + LABA → symbicort or advair * LT modifier → montelukast (singulair) * Anti- IgE MAB → omalizumab * Methylxanthines → theophyline aminophylline * Mast cell stabilizer → Cromolyn
60
What are some ways to treat status asthmaticus?
* O2 * β2 agonist * Steroids → hydrocortisone or methylprednisolone * IV fluid and IV mag sulfate * broad spectrum ABX * Ipratropium * Intubate when PaCO2 > 50 mmHg
61
When pre-oping an asthma patient what are some things to consider?
* onset age * triggers * accessory muscle use wheezing * stress dose steroids ABX bronchodilators
62
For an asthmatic what type of anesthesia is preferred?
* regional > GA
63
What anesthetic meds can be used to suppress hyper-reactive airway?
* fentanyl * remifentanil * lidocaine * prop * ketamine
64
What NMBDs should we avoid in an asthma patient?
Atracurium *Any histamine releasing NMBDs*.
65
What is COPD?
* progressive loss of alveolar tissue that is not reversible
66
What deficiency do COPD patients have?
* α1 - Antitrypsin
67
What is emphysema?
* destruction of lung parenchyma
68
What is chronic bronchitis?
* cough and sputum production
69
What are some risk factors for COPD? (this is not exhaustive list)
* smoking * occupational exposure to bad things * recurrent resp infections * low birth weight * asthma * age * female
70
What are some S/Sx of COPD?
* Dyspnea on exertion or at rest * chronic cough and sputum production
71
What is a COPD exacerbation?
Acute worsening of airflow obstruction
72
How is COPD diagnosed?
* FEV1/FVC < 70% normal * ↑ RV FRC and TLC * CXR → hyperinflation hyperlucency
73
What is Bullae associated with?
* emphysema
74
How do we treat COPD medically?
* Stop smoking * O2→ if PaO2 < 55mmHg Hct > 55% or if cor pulmonale * LABA corticosteroids anticholinergics * Flu / pneumonia vaccines * Diuretics
75
What is the goal of O2 therapy for COPD?
* PaO2 > 60 mmHg
76
How can we treat COPD surgically? How does it help?
* Lung volume reduction surgery * Help ↑ elastic recoil ↓ hyperinflation ↓ V/Q mismatch
77
What are some things to consider for COPD patient preop eval?
* smoking Hx * current meds * comorbidities * do they have RV failure * prior hospitalizations * optimize before surg * PFTs/ABGs * Ventilation
78
What are some preop risk reductions we can do for COPD patients?
* stop smoking for 6 weeks (8 weeks is even better) * treat respiratory infections * treat expiratory airflow obstructions * lung volume expansion maneuvers

Health Assessment - Spring 2025 (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions