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Peds Exam 1 Textbook > Peds Ch 13 (Respiratory) > Flashcards

Peds Ch 13 (Respiratory) Flashcards

1
Q

when does saccular stage begin and what forms

A

The saccular stage begins at approximately 24 weeks, when terminal air sacs begin to form.

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2
Q

The vast majority of alveolar formation occurs…

A

after birth

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3
Q

The abrupt transition to extrauterine gas exchange at birth involves …

A
  • the rapid expansion of the lungs
  • increased pulmonary blood flow
  • initiation of a regular respiratory rhythm.
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4
Q

things that cause an acute decrease in pulmonary vascular resistance and a consequent increase in pulmonary blood flow (2)

A

Changes in the partial pressures of

  • oxygen (PO2) and carbon dioxide (PCO2)
  • hydrogen ion concentration (pH)
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5
Q

what reverses the pressure gradient across the foramen ovale, causing functional closure of this left- to-right one-way flap valve

A
  • increased left atrial pressure
  • decreased right atrial pressure
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6
Q

function of the Hering-Breuer reflexes

A

prevent overdistention or collapse of the lung

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7
Q

function of parenchymal receptors

A

respond to hyperinflation of the lungs, to various chemical stimuli in the pulmonary circulation, and possibly to interstitial congestion.

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8
Q

chest wall receptors include (2)

A

mechanoreceptors and joint proprioceptors

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9
Q

The ____________ produces the majority of tidal volume during quiet inspiration

A

diaphragm

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10
Q

The ____________ produces expiration

A

elastic recoil of the lungs and thorax

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11
Q

During vigorous breathing or with airway obstruction, both inspiration and expiration become ________ processes.

A

active

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12
Q

infant chest wall compliance

A

In infants the chest wall is more compliant, so the tendency of the lung to collapse is not adequately counterbalanced by chest wall rigidity.

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13
Q

infants stop expiration at a lung volume (greater/ less than) FRC

A

greater than

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14
Q

possible complications of prematurity and prolonged intubation that may be exacerbated in the perioperative period (3)

A
  • apneic episodes
  • subglottic stenosis
  • tracheomalacia
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15
Q

use of PFT in children

A
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16
Q

Spirometry measures …

A
  • the volume of air inspired and expired as a function of time

by far the most frequently performed test of pulmonary function in children

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17
Q

An obstructive process is characterized by …

A

decreased velocity of airflow through the airways

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18
Q

a restrictive defect produces…

A

decreased lung volumes

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19
Q

Restrictive lung disease is associated with…

A

a loss of lung tissue or
a decrease in the lung’s ability to expand

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20
Q

most common obstructive disease in children

A

asthma

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21
Q

Restrictive lung disease can arise from …

A

limitations to chest wall movement, such as chest wall deformities, scoliosis, or pleural effusions, or from space-occupying intrathoracic pathology such as large bullae or congenital cysts

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22
Q

what can spirometry be used for

A

to assess the indication for, and efficacy of, treatment (usually asthma)

23
Q

____________ account for most of the perioperative morbidity in children and cause almost one-third of perioperative pediatric cardiac arrests

A

Respiratory problems

24
Q

The work of breathing is also greater in young infants as a result of (4)

A
  • high-resistance
  • small-caliber airways
  • increased chest wall compliance
  • reduced lung parenchymal compliance.
25
Q

____________ cause the majority of URIs

A

viruses

26
Q

Children with a recent or current URI have an increased incidence of

A
  • perioperative laryngospasm
  • bronchospasm
  • arterial hemoglobin desaturation
  • severe coughing
  • breath holding compared with uninfected children
27
Q

For children with symptoms of an uncomplicated URI who are afebrile with clear secretions and who are otherwise healthy…

A

anesthesia may proceed as planned

28
Q

Elective surgery is usually postponed for children with more severe symptoms that include at least one of the following:

A
  • mucopurulent secretions
  • lower respiratory tract signs that do not clear with a deep cough
  • pyrexia >100.4°F (38°C)
  • a change in sensorium
29
Q

The decision to proceed with surgery becomes much more difficult when the signs of the URI are …

A

between the extremes of mild and severe.

30
Q

The ____________ is associated with fewer episodes of respiratory events

A

laryngeal mask airway (LMA)

31
Q

The optimal time when an anesthetic can be given to a child after a URI without increasing the risk of adverse respiratory events remains contentious, but most clinicians wait ____________ after resolution of the URI before proceeding.

A

2 to 4 weeks

32
Q

Acute inflammation of the small airways may result in ____________ with edema of the small airways leading to desaturation, hypercapnia, and acute respiratory failure

A

bronchiolitis

33
Q

first-line treatment for bronchospasm involves:

A
  • removing the triggering stimulus if possible
  • deepening anesthesia
  • increasing the fraction of inspired oxygen (FIO2) if appropriate
  • decreasing the positive end-expiratory pressure (PEEP)
  • increasing the expiratory time to minimize alveolar air trapping
34
Q

in severe status asthmaticus, ventilations strategy focuses primarily on…

A

achieving adequate oxygenation, rather than attempting to normalize PaCO2 at the potential cost of inducing pulmonary barotrauma

35
Q

All children who experience anything more than minor bronchospasm should also receive ____________ , if they have not already done so.

A

corticosteroids

36
Q

first-line therapy for all children and is the most effective way of reversing airflow obstruction

A

short-acting β-agonists

37
Q

For severe exacerbations unresponsive to the treatment listed earlier, ____________ may decrease the likelihood of intubation, although the evidence is limited

A

IV magnesium

38
Q

how is bronchospasm from anaphylaxis differentiated from that due to asthma?

A

it produces additional systemic signs such as angioedema, flushing, urticaria, and cardiovascular collapse.

39
Q

what is Cystic Fibrosis

A

an autosomal recessive disorder that is caused by one of more than 1500 mutations in the gene coding for the CF transmembrane conductance regulator (located on chromosome 7), a protein that regulates chloride and other ion fluxes at various epithelial surfaces

40
Q

most common fatal inherited disease in Caucasians?

A

CF

41
Q

where is electrolyte transport disrupted with CF

A

in the epithelial cells of the sweat ducts, airways, pancreatic ducts, intestine, biliary tree, and vas deferens

42
Q

s/s of CF

A
  • increased sweat chloride concentrations
  • viscous mucus production
  • lung disease
  • intestinal obstruction
  • pancreatic insufficiency
  • biliary cirrhosis
  • congenital absence of the vas deferens
43
Q

main cause of morbidity and mortality in CF, and consequently it is the focus of anesthetic concern

A

lung disease

44
Q

lung disease in CF patho

A

involves mucus plugging, chronic infection, inflammation, and epithelial injury

45
Q

recurrent exacerbations of CF are associated with…

A
  • progressive airway
    obstruction
  • bronchiectasis
  • emphysema
  • ventilation/perfusion mismatching
  • hypoxemia
46
Q

pulmonary function abnormalities in CF typically follow what kid of pattern?

A

obstructive

47
Q

pulmonary function test findings in patients with CF?

A

increased FRC, decreased FEV1, decreased peak expiratory flow rate, and decreased vital capacity

compensatory hyperventilation typically produces a reduced PaCO2

48
Q

The most common indications for anesthesia in children are

A

nasal polypectomy and ear, nose, and throat surgery

as a result of the frequency of upper airway pathologic processes such as chronic sinusitis and nasal polyps

49
Q

Inhalation of ____________ in CF patients accelerates mucus clearance, increases lung function, and improves quality of life

A

hypertonic saline (7% sodium chloride)

50
Q

SCD patho

A

inherited hemoglobinopathy that results from a point mutation on chromosome 11

51
Q

what does the mutant gene of SCD code for ?

A

production of hemoglobin S, a mutant variant of the normal hemoglobin A.

52
Q

clinical manifestations of SCD

A
  • acute episodes of pain
  • acute and chronic pulmonary disease
  • hemorrhagic and occlusive stroke
  • renal insufficiency
  • splenic infarction
53
Q

acute lung injury caused by SCD

A

Acute Chest Syndrome (ACS)

54
Q

diagnosis of ACS

A

a new pulmonary infiltrate involving at least one lung segment on the radiograph (excluding atelectasis) combined with one or more symptoms or signs of:

  • chest pain
  • pyrexia greater than 101.3°F (38.5°C)
  • tachypnea, wheezing, or cough

Peds Exam 1 Textbook (7 decks)

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