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Anes 540b Exam 1 > Pulmonary Diseases + Axis, Hypertrophy, Enlargement > Flashcards

Pulmonary Diseases + Axis, Hypertrophy, Enlargement Flashcards

1
Q

What are the three causes of thrombosis according to Virchow’s triad?

A
  1. Venous stasis
  2. Vessel wall injury (abnormal vessels)
  3. Hypercoagulability
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2
Q

What are the two causes of venous stasis?

A
  1. Immobility

2. Reduced flow

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3
Q

Deficiencies of what proteins can cause hypercoagulability?

A

Proteins C, S

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4
Q

Malignancy is a large risk factor for what two conditions?

A

DVT

PE

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5
Q

Which heart valve is accentuated during PE?

A

Accentuation of S2; closing of pulmonic valve

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6
Q

What lung sounds may you hear in patient with PE?

A

Pulmonary friction rub

Rales

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7
Q

What two values will plummet in presence of massive PE?

A

BP and end-tidal CO2 plummets

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8
Q

Which type of chest pain indicates PE?

A

Pleuralistic pain

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9
Q

What three inotropes would we use in event of PE to recover massive decrease in BP?

A

Isoproterenol
Dopamine
Dobutamine

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10
Q

When massive PE is unresponsive to medical management, what is our next line of action?

A

Pulmonary artery embolectomy with CPB

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11
Q

How will you monitor arterial and cardiac filling pressures to manage IVF administration and optimize RV stroke volume?

A

PA catheter

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12
Q

What effects may pulmonary hypertension have on the heart (blockage in or narrowing of pulmonary artery)

A

Right chambers may enlarge.
Blood is often forced backward through tricuspid valve
Mitral valve stenosis (narrowing)

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13
Q

What is a common phosphodiesterase inhibitor used to treat pulmonary hypertension?

A

Viagra

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14
Q

What increases right-sided HF?

A

Hypoxia, hypercarbia

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15
Q

What are the two best treatments for COPD?

A

Quit smoking

Supplemental O2

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16
Q

What are two methods of post-op care for COPD patients?

A

Lung volume expansion techniques

Post-op analgesia with neuraxial opioids

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17
Q

Result of previous RSV infection

A

Bronchiolitis Obliterans

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18
Q

Develops after prolonged intubation or tracheostomy

A

Tracheal stenosis

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19
Q

What is asthma?

A

Chronic airway inflammation defined by reversible expiratory airflow obstruction + airway hyperreactivity

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20
Q

What are two pathological features of asthma?

A

Airway wall inflammation

Luminal obstruction of airways

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21
Q

What causes luminal obstruction of airways in asthma?

A

Inflammatory cells and mucous

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22
Q

Under what condition would you see a patient sitting in tripod position to ease breathing?

A

Asthma–dyspnea, “air hunger”

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23
Q

What is principal treatment for asthma patients?

A

Inhaled corticosteroids, a type of antiinflammatory drug

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24
Q

What are the three types of drugs that can treat asthma?

A

Antiinflammatory drugs
Bronchodilator drugs
Methylxanthines

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25
Q

What type of medications should asthmatic patients avoid? Why?

A

NSAIDS; may be a trigger for attacks

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26
Q

What characterizes restrictive lung disease?

A

Decrease in total lung capacity

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27
Q

What causes restrictive lung disease?

A

An intrinsic disease process that alters the elastic properties of the lungs, causing the lungs to stiffen

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28
Q

What are four main causes of restrictive lung disease?

A

Acute intrinsic restrictive lung disease
Chronic intrinsic restrictive lung disease
Chronic extrinsic restrictive lung disease
Disorders of pleura and mediastinum

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29
Q

RLD causes TLC =

A

<80% of expected value

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30
Q

An increase in muscle mass is known as:

A

Hypertrophy

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31
Q

Dilation of a particular chamber is known as:

A

Enlargement

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32
Q

What leads immediately indicate whether or not heart axis is normal? What defines normalities?

A

Leads I and aVF–normal positive QRS complexes in these leads = normal axis

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33
Q

What degrees define a normal heart axis?

A

0-90*

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34
Q

If either lead I and aVF are negative, it indicates that:

A

axis is abnormal

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35
Q

Which leads overlie the right side of the heart?

A

II, III, aVF

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36
Q

Which portion of the P-wave is affected in left atrial enlargement?

A

2nd portion

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37
Q

Which type of atrial enlargement causes longer P-wave?

A

Left atrial enlargement

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38
Q

Which type of atrial enlargement causes longer P-wave?

A

Left atrial enlargement

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39
Q

Why does the left atrium enlarge?

A

Issue with mitral valve, such as mitral valve regurgitation

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40
Q

Which leads diagnose right atrial enlargement?

A

Leads II and V1

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41
Q

In what type of enlargement do you only see peaked P-wave, not wide P-wave?

A

Right atrial enlargement

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42
Q

Why isn’t there usually significant axis deviation in left atrial enlargement?

A

LA is normally electrically dominant anyways.

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43
Q

In limb leads, most common feature is:

A

Right axis deviation–shifted to 90-180*

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44
Q

What kind of changes occur to QRS complex in lead I in right ventricular hypertrophy?

A

Must be slightly more negative than positive

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45
Q

Which kind of hypertrophy results in increased R-wave amplitude in leads overlying left ventricle and increased S wave amplitude in leads overlying right ventricle?

A

Left ventricular hypertrophy

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46
Q

What is a pulmonary embolus?

A

a blockage in the pulmonary artery

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47
Q

Cause of PE?

A

A pulmonary embolism is caused by blood clots that travel to the lungs from another part of the body most commonly, the legs

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48
Q

PE = complication of what condition?

A

DVT

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49
Q 
Old age
Obesity
Severe illness
Stroke
Spinal injury
Guillian-Barré syndrome
Trauma

All causes of:

A

Immobility, a cause of venous stasis

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50
Q 
Cardiogenic shock
Myocardial infarction
Pregnancy 
Pelvic tumors
Perioperative venous occlusion

All causes of:

A

Reduced flow, a cause of venous stasis

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51
Q

Trauma
Phelbitis
Previous DVT

All causes of:

A

abnormal vessels

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52
Q

Smoking, maligancy, pregnancy, and oral contraceptives can all affect what part of Virchow’s Triad?

A

Increased coaguability

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53
Q

A PE manifests as what kind of chest pain?

A

Pleuritic

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54
Q

Describe cough associated with PE.

A

Non-productive, though may be blood-tinged

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55
Q

What sign around the mouth and fingertips could you look for in a patient with a PE?

A

Cyanosis

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56
Q

Which pulmonic valve sound would be accentuated in a patient with a PE?

A

S2 (pulmonic valve)

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57
Q

What two lung sounds might you hear in a patient with a PE?

A

Pulmonary friction rub

Rales

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58
Q

What sign around the patient’s neck would indicate presence of a PE?

A

JVD

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59
Q

Describe patient vital signs with PE.

A

Dyspnea
Tachypnea (>20 breaths/min)
Tachycardia (>100 BPM)
Fever

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60
Q

Worst possible outcome of patient with PE would be:

A

CV collapse/sudden death

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61
Q

Medical imaging using scintigraphy and medical isotopes to evaluate the circulation of air and blood within a patient’s lungs

A

V/Q scan

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62
Q

V/Q scans are useful in determining the

A

V/Q ratio

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63
Q

What two tools are used for a V/Q scan?

A

Medical isotopes and scintigraphy

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64
Q

Sonogram of the lower extremities to evaluate for DVT

A

Venous ultrasonogrphy

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65
Q

What does a normal venous ultrasonography tell us about the possibility of a PE?

A

Normal venous ultrasonography doesn’t exclude PE.

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66
Q

Injection of radiocontrast into circulation with fluoroscopy of the lungs

A

Pulmonary angiography

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67
Q

CT slices in a helical pattern for increased resolution

A

Spiral CT scan

68
Q

Anticoagulation treatments for PE:

A

Heparin

Warfarin

69
Q

If a patient has PE, we will manage their airway via:

A

intubation and mechanical ventilation with PEEP

70
Q

Mean pulmonary artery pressure >25 mmHg at rest with a PCWP, LAP, or LVEDP of <15 mmHg

A

Pulmonary hypertension

71
Q

Three causes of pulmonary hypertension:

A

Pulmonary vasoconstriction
Vascular wall remodeling
Thrombosis

72
Q

In pulmonary hypertension, why does RV wall stress increase?

A

In response to increased afterload produced by pulmonary artery hypertension

73
Q

If patient presents with breathlessness, weakness, fatigue, abdominal distention, syncope, angina pectoris, or myocardial ischemia, you should suspect:

A

Pulmonary artery hypertension

74
Q

What gallop might you hear in a patient with PAH?

A

S2, S3 gallop

75
Q

Why should you be careful with sedatives in patients with pulmonary hypertension?

A

Increase PVR

76
Q

Preoperatively, treat patient with PAH with:

A

Sildenafil or L-arginine

Inhaled NO or prostacyclin

77
Q

Why should you use caution with Ketamine and Etomidate in patients with PAH?

A

They can cause pulmonary vasorelaxation

78
Q

What kind of monitoring is recommended in patients with PAH?

A

central venous catheter + A-line

79
Q

Name four pulmonary vasodilators?

A

NTG, NO, milrinone, prostacylcin

80
Q

Characterized by the progressive development of airflow limitation that is not fully reversible

A

COPD

81
Q

COPD encompasses:

A

chronic obstructive bronchitis + emphysema

82
Q

obstruction of small airways

A

Chronic obstructive bronchitis

83
Q

enlargement of air spaces and destruction of lung parenchyma

A

Emphysema

84
Q

Presence of a productive cough of more than 3 months duration for more than 2 successive years indicates:

A

Chronic bronchitis

85
Q

What is the persistent cough in chronic bronchitis due to?

A

Cough due to hypersecretion of mucus and not necessarily accompanied with airflow limitation

86
Q

Characterized by a destructive process involving the lung parenchyma that results in loss of elastic recoil of the lungs

A

Emphysema

87
Q

Why does emphysema increase airway resistance?

A

Airway collapse occurs during exhalation, leading to increased airway resistance

88
Q

If you see a patient with severe dyspnea with use of accessory muscles, be suspicious of:

A

emphysema

89
Q

Changes to lungs in chronic bronchitis

A

Inflammation and structural changes

Increased mucus

90
Q

Changes in lungs due to emphysema

A

Destruction and enlargement of air spaces

91
Q

Upon physical exam, your patient shows tachypnea, prolonged expiration, decreased breath sounds, and expiratory wheezes. Suspect:

A

COPD

92
Q

Patients with COPD will have what lung sounds?

A

Expiratory wheezes

93
Q

< FEV1/FVC ratio

A

COPD

94
Q

< FEF25-75(forced expiratory flow between 25-75% of VC)

A

COPD

95
Q

> RV

A

COPD

96
Q

> FRC and TLC

A

COPD

97
Q

What three changes might you see in chest radiography in patient with COPD?

A

1) Hyperlucency of lungs:arterial vascular deficiency
2) hyperinflation (flattening of diaphragms)
3) bullae

98
Q

Pink puffers (emphysema) have PaO2 of:

A

> 65 mmHg

99
Q

Blue bloaters (chronic obstructive bronchitis) have PaO2 of:

A

<65 mmHg

100
Q

Blue bloaters (chronic obstructive bronchitis) have PaCO2 of:

A

<45 mmHg

101
Q

Drug therapy of COPD includes:

A

Bronchodilators (B2 agonists)
Anticholinergics
Inhaled corticosteriods
Antibiotics

102
Q

COPD treatment, surgical removal of overdistended areas allow for normal lung tissue to expand

A

Lung volume reduction surgery

103
Q

Chronic suppurative disease of the airways of infective ideology causing destruction of airways and recurrent infections

A

Bronchiectasis

104
Q

Mutation in chloride ion transport resulting in viscous secretions resulting in luminal airway obstruction

A

Cystic Fibrosis

105
Q

Congenital impairment of ciliary activity in respiratory tract epithelial cells and sperm tails (chronic sinusitis, OM, productive cough & infertility)•

A

Primary Ciliary Dyskinesia

106
Q

Narrowed airway, tightened muscles + inflamed/thickened airway all, and mucus

A

Asthma

107
Q

Expiratory sound produced by turbulent gas flow through narrowed airways during asthma

A

Wheezing

108
Q

10 minutes post-bronchodilator, you will see lung compliance improve by what percentage in asthmatic patients?

A

20%

109
Q

At baseline, the flow-volume loop in asthmatic patients is

A

concave

110
Q

Unlike in obstructive lung diseases, in RLDs what two values are preserved?

A

Expiratory flow rates

FEV1/FVC is preserved

111
Q

In RLD, hypercarbia/arterial hypoxemia leads to vasoconstrictive pulmonary hypertension, ultimately resulting in:

A

Cor pulmonale

112
Q

In RLD, weakness of expiratory muscle from neuromuscular disease leads to ineffective cough, ultimately resulting in:

A

recurring atelectasis + pneumonia

113
Q

How is FEV1/FVC ratio preserved in restrictive lung disease if both FEV1 and FVC are reduced?

A

FVC is decreased much more so than FEV1.

114
Q

Treatment of RLD

A

Corticosteroids, immunosuppressive agents, and cytotoxic agents

115
Q

Last resort treatment of RLD=

A

lung transplant

116
Q

Inability of the patient’s lungs to provide adequate arterial oxygenation with or without acceptable elimination of CO2

A

Acute respiratory failure

117
Q

What is an important factor in development of acute respiratory failure?

A

Fatigue of the muscles of breathing

118
Q

ABG in patient with ARF?

A

PaO2 < 60 mmHg

PaCO2 < 50 mmHg

119
Q

How does ARF differ from CRF?

A

In ARF, pH is normal. IN CRF, pH decreases.

120
Q

How do FRC and TLC change in ARF?

A

decreased

121
Q

What develops if ARF persists?

A

Pulmonary hypertensionand diffuse opacification

122
Q

Caused by pressure overload in which the ventricle pumps against increased resistance (afterload)

A

Hypertrophy

123
Q

Typically caused by volume overload in which the chamber dilates to accommodate an increased amount of blood as a result of valvular insufficiency (AR & MR)

A

Enlargement

124
Q

Hypertrophy is demonstrated in what conditions?

A

HTN + aortic stenosis

125
Q

Enlargement is demonstrated in what conditions?

A

Mitral regurgitation and aortic regurgitation

126
Q

What part of the EKG do we use to assess atrial enlargement?

A

P-waves

127
Q

What part of the EKG do we use to assess ventricular hypertrophy?

A

QRS complex

128
Q

If a chamber enlarges/hypertrophies, it can take longer for it to depolarize. How would this effect the EKG?

A

The wave may increase in duration.

129
Q

If a chamber enlarges/hypertrophies, it can generate more current and thus a larger voltage. How would this effect the EKG?

A

The wave may increase in amplitude.

130
Q

If a chamber enlarges/hypertrophies, a large percentage of the total electrical current can move through the expanded space. How would this effect the EKG?

A

The mean electrical vector (axis) would shift.

131
Q

If the wave of depolarization is moving toward it, a lead will record:

A

a positive wave

132
Q

If the wave of depolarization is moving away from it, the lead will record:

A

a negative wave

133
Q

Depolarizations that move from negative to positive charge results in what kind of wave?

A

Positive

134
Q

Depolarizations that move from positive to negative charge results in what kind of wave?

A

Negative

135
Q

If Lead I and aVF are both negative, describe axis of heart.

A

Extreme axis deviation

136
Q

If Lead I is negative and aVF is positive, describe axis of heart.

A

Right axis deviation

137
Q

If Lead I and aVF is positive, describe axis of heart.

A

Normal

138
Q

If Lead I is positive and aVF is negative, describe axis of heart.

A

Left axis deviation

139
Q

The direction of the mean electrical vector, representing the average direction of current flow

A

Axis

140
Q

The axis of the heart is only defined in what plane?

A

Frontal plane

141
Q

Duration of normal p-wave on EKG?

A

<0.12 sec

142
Q

The largest deflection of the isoelectric line (+ or -) should not exceed:

A

2.5 mm.

143
Q

Which atrium depolarizes first?

A

Right atrium

144
Q

Which leads assess right atrial enlargement?

A

Lead II and V1

145
Q

The lead that is oriented parallel to the flow of current through the atria and therefore most positive during atrial depolarization

A

Lead II

146
Q

The lead that is oriented perpendicular to the flow of current and therefore biphasic during atrial depolarization

A

Lead V1

147
Q

Which portion of the P-wave increases in amplitude with right atrial enlargement?

A

1st portion of the p-wave

148
Q

If the axis swings rightward during depolarization of the atria, what lead should you look at as parallel for conductance through atria instead of Lead II?

A

aVF or lead III

149
Q

When can you diagnose right atrial enlargement?

A

When there are tall P-waves in leads II, III and aVF

150
Q

Which portion of the P-wave increases in amplitude with left atrial enlargement?

A

2nd portion of the P-wave

151
Q

In order to diagnose LAE, the p-wave should drop at least 1mm below the isoelectric line in which lead?

A

V1

152
Q

There is a more prominent increase in duration in the p-wave when which atrium is enlarged?

A

LA

153
Q

RAE is also known as:

A

P pulmonale because it is often caused by severe lung disease.

154
Q

LAE is also known as:

A

P mitrale because mitral valve disease is the most common cause of LAE.

155
Q

Most common cause of LAE?

A

Mitral valve disease

156
Q

If RAE, p-waves will have an amplitude that exceeds _________ in which leads?

A

2.5 mm

In inferior leads

157
Q

Which type of atrial enlargement increases P-wave duration?

A

LAE

158
Q

Why is no significant axis deviation seen during LAE?

A

The LA is electrically dominant anyway–the shift only occurs when less dominant atrium takes over.

159
Q

In order to diagnose right ventricular hypertrophy, the QRS complex must be slightly more negative than positive in which lead?

A

Lead I

160
Q

In right ventricular hypertrophy, R-wave progression is disrupted:
in V1…
in V6…

A

In V1, the R-wave is larger than the S-wave.

In V6, the S-wave is larger than the R-wave

161
Q

Increased R wave amplitude in leads overlying the left ventricle and increased S wave amplitude in leads overlying the right ventricle

A

Left ventricular hypertrophy

162
Q

In order to be considered LVH, R wave amplitude in lead V5 or V6 plus the S wave amplitude in lead V1 or V2 exceeds:

A

35 mm

163
Q

In order to be considered LVH, R wave amplitude in V6 exceeds R-wave amplitude in which lead?

A

V5

164
Q

In order to be considered LVH, the R wave amplitude in lead AVL exceeds:

A

13 mm

165
Q

Right axis deviation present, with the QRS axis exceeding +100*

A

RVH

Anes 540b Exam 1 (4 decks)

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