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DSouza 2015 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

When comparing base of lung to apex, the base lung has …

A

Smaller alveoli
Grater compliance
Low V/Q ratio
Less negative intrapleural pressure

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2
Q

Respiratory center and their location in CNS?

Inspiration center ->
Expiration Center ->
Apneustic Center ->
Pnumotoxic Center ->

A

Inspiration center -> Medulla
Expiration Center -> Medulla
Apneustic Center -> Lower Pons
Pnumotoxic Center -> upper Pons

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3
Q

What respiratory center responsible for basic rhythm of respiration ?

A

Medullary inspiration center

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4
Q

Biots’ breathing is …. and caused by …

A

Quick shallow respiration followed by apnea.

Injuries to Medulla

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5
Q

Cheyne strike breathing is … and caused by …

A

Periods of apnea and hyperapnea

Sleep, high altitude, morphine, CHF, brain injury/tumor, metabolic encephalopathy, CO poisoning

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6
Q

Deep, Labored breathing is …

A

Kusmual breathing, caused by DKA

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7
Q

What stimulates respiration at the central chemoreceptors level?

A

CNS H+ and HC3 ions (not peripheral H because it won’t cross BBB)

CO2 -> diffuses to CSF through BBB and forms carbonic acid -> then it dissociates into H+ and HC3 which they stimulates chemoreceptors

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8
Q

Peak airway pressure originated from ….

Plateau pressures originated from ….

A

Large airways

Pressure measured at alveolar level

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9
Q

Static compliance is

A

Static -> plateau airway pressure

  • it is pulm compliance during period without gas flow
    e. g. inspiratory pause

C (stat) = VT/Pplat - PEEP

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10
Q

Total compliance =

A

1/TC = 1/Cw + 1/CL

CT= Total compliance 
Cw = chest wall compliance 
CL= lung compliance
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11
Q

Dynamic compliance is …

A

Dynamic-> peak airway pressure

  • it represents pulm compliance during period of gas flow
    e. g. inspiration period

Cdyn = VT/PIP -PEEP

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12
Q

Pulm fibrosis or emphysema increases pulm compliance?

A

Emphysema-> increases compliance

Fibrosis-> decreases it

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13
Q

How would hyperbaric O2 increases O2 content?

A

By increasing the amount of dissolved O2

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14
Q

CO2 carried in blood by 3 forms …

A

Dissolved 10%
Carbamino compound 30%
HCO3 60%

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15
Q

The buffers in

Blood ->
Interstitial fluid ->
Intercellular fluid ->

A

Blood -> plasma protein, Hgb, HCO3

(Hgb has greater buffering capacity than HCO3 in blood) gap in knowledge 2010

Interstitial fluid -> HCO3
Intercellular fluid -> protein & Po4

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16
Q

Deoxygenated blood that increases its ability to carry CO2 in peripheral tissue is … effect

A

Haldane

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17
Q

Effect PaCO2 on OxyHgb dissociation curve is …. effect

A

Bohr

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18
Q

The primary contributor to the venous admixture or physiological shunt is …. vessels

A

Bronchial

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19
Q

Coronary sinus drains into …. atrium. And dose or Diane not contribute to physiological shunt?

A

Right atrium

Dose not

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20
Q

…. vessels drains directly into chambers of the heart and contribute to the physiological shunt.

A

Thebesian vessels

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21
Q

FRC measured by

A

Body plethysmography and helium dilution technique

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22
Q

Stopping smoking a week before surgery will decrease … and this will increase…..

A

Carbon monoxide level

Increases P50 and O2 carrying capacity

Where other pulm function needs longer period of stopping smoking to return to normal.

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23
Q

What is the difference between measured arterial PaCO2 and exhaled CO2 is ….

A

Physiological dead space.

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24
Q

Dead space increases or decreases with the following

Age

Neonates
Pregnancy
Obesity

A

Increases in elderly (keyword)

All others are similar compared to adults ???

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25
Q

FRC increases or decreases in following

Neonates
Obesity 
Pregnancy 
Supine
GA
Emphysema
A

All decrease Except emphysema (increases FRC)

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26
Q

What is the volume refer too where the small airway begins to close?

A

Closing capacity

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27
Q

What is the primary etiology for hypoxemia in obese and elderly patients?

A

Closing capacity approaches the FRC during tidal ventilation

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28
Q

FRC and closing capacity in elderly vs obesity

A

Elderly
FRC -> normal/increase
CC -> increases

Obesity
FRC -> decreases
CC -> normal

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29
Q

PEEP increases …. and decreases …

A

FRC
Dead space
Pulm compliance
RV afterload

It decreases

  • venous return
  • pulm artery occlusion pressure (LV afterload).
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30
Q

Pulm mechanics in elderly?

A

Increase

  • lung compliance
  • FRC
  • RV
  • anatomical dead space
  • closing capacity
  • pulm vascular resistance
  • pulm artery pressure

Decreases

  • chest wall compliance
  • VC
  • diffusion capacity
  • PaO2
  • hypoxia pulm vasoconstriction
  • ventilatory response hypoxia & hypercarbia
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31
Q

Closing capacity dose not increase in obesity, but it dose in …

A

Elderly

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32
Q

What you expect lung volumes changes in obesity?

Why shunt increases in obesity although closing capacity stays the same in obesity?? (Gap x2)

A

FRC, ERV, VC, and TLC -> decreases

RV, Dead space space, and closing capacity-> unchanged

FRC < closing capacity which results into air trapping and leads to increased shunt (key gap)

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33
Q

What’s the % of O2 consumption used for work of breathing in adults?

A

1-2%

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34
Q

What’s the maximum FiO2 can Nasal cannula delivers?

A

0.45%

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35
Q

The best sign of preoxygenation is …

A

EtO2 > 0.9

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36
Q

Endo-bronchial intubation and effect hypoxia caused by?

When decrease in PaO2 and rise in PaCO2 starts to show up, what is the % of shunting?

A

Decrease in PaO2 (which later picked up by SaO2 when PaO2 falls below 100 mmHg)

Right to left shunting caused by unventilated lung.

PaO2 won’t change unless the shunting fraction > 50% (liner decrease in PaO2 with increased shunting), and PaCO2 begins to rise when shunt > 50%

37
Q

Increased PaCO2 and (PaCO2 - EtCO2 gradient) is a sign of ….

A

Dead space

Where in shunting, the PaCO2 rises up when the shunting fraction > 50%

38
Q

What’s the primary cause of v/q mismatch in laparoscopic surgery?

A

Physiological dead space (increased) due to abdominal destination and trendelenburg position, controlled mechanical ventilation and decreased CO.

39
Q

Reason for v/q mismatch in mechanical ventilation?

A

Increased Dead space ventilation of non-dependent lung zone

40
Q

PEEP decreases VR -> decreases CO -> decreases….

A

MAPs

41
Q

Shift of ODC curve to left decreases/increases P50 and O2 affinity?

A

Left -> decreases P50 -> increases O2 affinity

Right shift is the opposite

42
Q

Left shift of oxy- Hb dissociation curve causes?

A 
MethHgb
Carboxy Hgb
Fetal Hgb
Hypovothermia
Decrease H+
Decrease in 2,3 DPG level
43
Q

Right shift of oxy- Hb dissociation curve causes?

A 
Sickle cell 
Thalassemia 
Pregnancy 
Acidosis 
Hyperthermia 
Increase in 2,3 DPG levels
44
Q

Hypercarbia shift Oxy-Hg dissociation curve to …

A

Right

Increase O2 release to tissue

45
Q

Both Carboxy Hgb and Methemoglobinemia causes no effect on PaO2 but both leads to hypoxia and one of the would show decreases O2 sat, which one?

A

Methemoglobinemia

Carboxy-Hgb would be normal pulse ox and it’s measured using co-oximeter to measure saturation

46
Q

Drugs causing Methemoglobinemia?

A 
Prilocaine
Nitroglycerin 
Na nitroprusside 
Phenytoin 
Sulfonamides
Metoclopramide
47
Q

Most reliable sign of cyanide toxicity is…. and which is the early sign.

A

Metabolic acidosis more than elevated SvO2 (which is early sign)

Other ewarning is when having Tachyphylaxis for Na nitroprusside

48
Q

Treatment for

Carboxy Hb

Methemoglobinemia

Cyanide toxicity

A

Carboxy Hb -> 100% O2 + hyperbaric

Methemoglobinemia -> Methylene blue, exchange transfusion, Hyperbaric

Cyanide toxicity-> Na Thiosulphate, Na nitrate, hydroxycoblamine, hyperbaric

49
Q

CO posing symptoms by it blood level;

< 20
20-40
40-60
> 60

What’s the lethal carboxy-Hb blood level?

A

< 20 (headache, dizziness, confusion)

20-40 (N/V, disorientation, visual impairments)

40-60 (agitation, combativeness, coma, shock)

> 60 (death)

50
Q

Why 100 O2 or hyperbaric O2 is used in CO poison?

A

It decreases the t1/2 of COHb

It increases dissolved O2 in blood.

51
Q

What are indications for hyperbaric therapy in CO poisoning?

A

Hx of neuro impairments

Sx or evidence of cardiac abnormalities. (MI, arrhythmias)

COHb level > 25%

52
Q

C/I to methylene blue ?

A

Cyanide poisoning
G6PD
SSRI use
ARF *** safe the kidneys

53
Q

Indications for methylene blue

A

Methemoglobinemia

Vasoplegia

54
Q

Indications for methylene blue are …

A

Methemoglobinemia

Vasoglegia

55
Q

Hyperbaric O2 is useful in which poisoning …

A

CO
Cyanide
Methemoglobinemia

56
Q

When ptn has smoked inhalational from confined airway fire, with clinical signs of airway injuries, ptn should be …

A

Intubated

57
Q

A patient with acute asthma should be managed with ventilation that is ….

A

Slower RR.

Inadequate expiration time will lead to air trapping and increased intrathoracic pressure and hypotension

58
Q

Condition. -> flow volume loop abnormalities

Variable extra thoracic —->

Variable intrathoracic—->

Fixed —->

A

Inspiration decrement

Epilators decrement

Both decrement

59
Q

What type of anesthesia for following:

Post tonsillectomy bleeding ->

Large mediastinal mass compressing airway ->

Large laryngeal mass ->

A

IV RSI

Awake FOB or inhlational with spontaneous ventilation

Awake tracheostomy

60
Q

The most common cause of desaturation one PACU is

A

Atelectasis

61
Q

The most common cause of increased peak airway after positioning to trendelenburg is

A

Endobronchial intubation

62
Q

Diagnostic modality of choice for anterior mediastinal mass is …

A

CT (not flow volume loops)

63
Q

Complications should be aware with anterior medistinal mass are

A

SVC or PA obstruction

Manage by maintain preload, avoid factors increasing PA pressure, maintenance of spontaneous ventilation and have rigid bronchoscope in room with CPB standby.

64
Q

Central sleep apnea may be predisposed by …

A

CHF, narcotic overdose and recent stroke

65
Q

The slope of airway pressure waveform In VC mode is …. vs in PC mode ….

A

Decreases as more volume enters the lung, where the slope is constant across each breath in PC mode and the waveform appears flat

66
Q

What are the setting can be changed in HFJV?

A

Airway pressures, RR, and I:E ratio

TV is not set

67
Q

Settings can be changed in HFOV?

A

Frequency, amplitude, mean airway pressure, FiO2

TV is not in the setting of this mode ventilation

68
Q

Describe the mechanism of gas exchange in laminar flow

A

Middle of small airway have laminar flow where margins of alveoli have opposite flow direction

69
Q

Describe the mechanism of gas exchange in pendulluft ventilation

A

Movement of inspired gas from those alveoli that fill fastest to those fill slowly

70
Q

Describe the mechanism of gas exchange in Taylor dispersion/connective streaming ventilation

A

Diffusion of high velocity central gases to the margins of airway. This helps gas mixing and exchange in smaller airway

71
Q

What respiratory changes expected after lung transplant

A
  • loss of cardinal cough reflex, distal to anastomosis
  • loss of neurally mediated bronchomotor tone
  • oxygenation is NORMAL
  • Arterial hypercarbia expected in first month post transplant then normalizes
  • ventilatory response to CO2 returns to normal beyond one month after transplant
72
Q

What are the numbers indicates poor outcome after lung resection?

A

O2 use: VO2 max < 15 mL/kg/min

O2 removal: postop predictive FEV1 < 30%

O2 delivery: DLCO < 40%

Other: FEV1 < 2L, MVV < 50%, RV/TLC > 50%

Postop predictive FEV1 = FEV1 (1-% resected/100)

73
Q

What inhibits HPV?

A

Hypocapnia

Inhalational agents

74
Q

In left lateral decubitus during spontaneous ventilation, v & q are higher in the …

A

Dependent lung compared to non-dependent lungs

75
Q

When sudden desaturation occur in OLV, first step …

A

Inform surgeon > 2 lung ventilation > confirm ETT position

If desaturation happens gradually then, add PEEP to dependent lung then CPAP to non dependent lung

76
Q

What dose clamping of pulm artery by surgeon during OLV causes?

A

Clamping the pulm artery on operative side will eliminate the shunt and improve oxygenation

77
Q

What’s the preferred mode of ventilation in patient with bronchopleural fistula?

A

HFJV

If not available then use OLV by DLT

78
Q

Protective lung ventilation in ARDS is …

A

TV < 6 mL/kg and end inspirartory plateau pressure < 30 cm H2O

79
Q

Acute exposure to high altitude causes

A

Hyperventilating (2/2 stimulation of peripheral chemoreceptors due to decrease in PaO2)

Resulting into respiratory alkalosis

80
Q

What are the adaptation of chronic exposure to high altitude

A
  • increased sensitivity to rise in PaCO2
  • increase in HPV leading to increase PVR
  • decreases PaO2, PaCO2 and HCO3
81
Q

The ABG In pulm embolism shows

A

Hypoxemia and respiratory alkalosis

82
Q

How dose prone position in ARDS decreases mortality?

A

Increases FRC, better drainage of secreations and improving oxygenation

83
Q

What is it like the PFT in ascites

A

Restrictive pattern (decreased FEV1, FVC and normal FEV1/FVC)

All lung volumes and pulm compliance decreases

84
Q

Negative pressure pulm edema causes by …

A

Inhalation or exhalation against obstruction

85
Q

Etiology of atalectasis during perioperative period?

A
  • decreases FRC, thoracic and pulm compliance
  • increased absorption of alveolar gas in area of low V/Q areas
  • decreases production of surfactant
86
Q

Cough reflex mediated by …

A

Afferent: vagus
Efferent: vagus, phrenic, spinal motor nerves
cGMP mediated

87
Q

Signs of correct DLT position on bronchoscope?

A
  • Tracheal rings anteriorly
  • RUL bronchus at 12 O’clock within a short distance from carina
  • Trifurcation of RUL bronchus
  • Bifurcation of LUL bronchus
88
Q

What’s the maximum leak pressure of uncuffed ETT ?

A

20-30 cm of water

89
Q

What’s the effect of positive pressure ventilation on heart, and kidneys

A

Decreases VR and CO

Decreases RBF, GFR, Na excretions and UO.

DSouza 2015 (21 decks)

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