Respiratory

Question 1

Triggers the end of inspiration by inhibiting the DRG.

Strong stimulus: rapid shallow breathing
Weak stimulus: slow and deep breathing

Answer 1

Pneumotaxic center

Question 2

Antagonizes pneumotaxic center which causes inspiration
(Stimulates DRG)

Answer 2

Apneustic center

Question 3

What inhibits the apneustic center?

Answer 3

Pulmonary stretch receptors (J receptors)

Question 4

Causes inspiration (respiratory pacemaker)

Answer 4

Dorsal respiratory group

Question 5

Causes expiration

Answer 5

Ventral respiratory group

Question 6

____ drives the respiratory pacemaker in the DRG

Answer 6

H+

Question 7

______ concentration in the CSF is the most important stimulus for the central chemoreceptor

Answer 7

Hydrogen ion

Question 8

What drugs can be given down the ETT?

Answer 8

NAVEL:

Narcan
Atropine
Vasopressin
Epi
Lidocaine

Question 9

In a patient undergoing pneumonectomy with OLV, crystalloid administration should be limited to?

Answer 9

< 3L in 24 hrs

Question 10

Tracheal cuff pressure should be less than ___?

Answer 10

25 cmH20

Question 11

How much cricoid pressure awake and after LOC?

Answer 11

Awake: 20 newtons ~ 2kg
After LOC: 40 newtons ~ 4kg

Question 12

Peds ETT w/o cuff?

Answer 12

(Age/4) + 4

Question 13

Peds ETT w/ cuff

Answer 13

(Age/4) + 3.5

Question 14

Peds ETT depth

Answer 14

Internal diameter x 3

Question 15

Max cuff pressure of LMA (not PPV pressure)

Answer 15

60 cmH20 (target = 40-60)

Question 16

Anterior epiglottis supplied by:
Posterior epiglottis supplied by:

Answer 16

Glossopharyngeal (CN IX)
SLN (internal branch CN X)

Question 17

Which pulmonary function test is the MOST sensitive indicator of small airway disease (obstruction)?

Answer 17

Forced expiratory flow at 25-75% vital capacity

Question 18

Volume of air that can be exhaled after a maximal inhalation.
Normal value?

Answer 18

FVC
Male= 4.8L
Female= 3.7L

Question 19

What FEV1/FVC ratio suggests obstructive dz?

Answer 19

<70%
(Normal with restrictive)

Question 20

Normal value of DLCO

Answer 20

17-25 ml/min/mmHg

Question 21

Answer 21

Question 22

Which drugs increase PVR?

Answer 22

Nitrous oxide, ketamine, Desflurane

Question 23

How does carbon monoxide affect the pulse ox?

Answer 23

May give a falsely elevated result

Question 24

What color is the pt with carbon monoxide poisoning?

Answer 24

cherry red appearance (not cyanotic)

Question 25

How does O2 supplementation affect carboxyhemoglobin?

Answer 25

Reduces t1/2 from 4-6 hrs on room air to 60-90 min with 100% O2. (O2 therapy continued until CoHgb < 5% or for 6 hrs)

Question 26

When is hyperbaric O2 needed for CO poisoning?

Answer 26

CoHgb > 25% or the pt is symptomatic

Question 27

What is the risk of carbon monoxide formation with soda lime greatest to least?

Answer 27

Des > Iso >>>> Sevo

Question 28

Strong indications for mechanical ventilation

Answer 28

Vital capacity < 15mL/kg Inspiratory force < 25 cmH2O PaO2 < 200 mmHg (on 100% FiO2) A-a gradient > 450 mmHg (on 100% FiO2) PaCO2 > 60 mmHg RR > 40 or < 6 bpm

Question 29

Answer 29

bronchopleural fistula & pulmonary infection

Question 30

What are the best predictors of post pulmonary complications for pts undergoing pulmonary surgery?

Answer 30

FEV1 < 40% predicted DLCO < 40% predicted VO2 max < 15mL/kg/min

Question 31

What is the youngest age you can use a DLT? What size?

Answer 31

8-9 yrs 26F

Question 32

Answer 32

Question 33

What is the hallmark of ARDS?

Answer 33

hypoxemia despite increased supplemental oxygen

Question 34

What tidal volumes do we use for ARDS?

Answer 34

4-6 mL/kg (normal 6-8 mL/kg)

Question 35

What is the most common pulmonary etiology of ARDS?

Answer 35

pneumonia

Question 36

What is the most common extra-pulmonary etiology of ARDS?

Answer 36

sepsis

Question 37

What variable is reduced by dynamic hyperinflation?

Answer 37

Inspiratory capacity

Question 38

What lab value is a predictive marker for post-op pulmonary complications for non-thoracic surgery?

Answer 38

albumin

Question 39

What technique is the gold standard for managing the difficult airway?

Answer 39

Flexible fiberoptic bronchoscope with patient awake and spontaneous ventilation

Question 40

Answer 40

Question 41

In general, increased dead space affects _____ and increased shunt affects _____

Answer 41

PaCO2; PaO2

Question 42

Answer 42