Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Apex > Respiratory Pathophysiology > Flashcards

Respiratory Pathophysiology Flashcards

1
Q

What has the most significant effect on airflow resistance?

A

Airway radius

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

Does PNS stimulation result in bronchoconstriction or bronchodilation?

A

Bronchoconstriction via the Vagus

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

Does mast cell stimulation result in bronchoconstriction or bronchodilation?

A

Bronchoconstriction

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

What sympathetic nerve causes bronchodilation?

A

No nerves. The beta 2 receptors are activated by circulating catecholamines, not nerves.

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

Cholinergic nerves endings release _____ onto ______ receptors.

A

Acetylcholine
M3 Receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the effect of Phospholipase C activation in airway tissues?

A

Causes an increase in intracellular calcium, resulting in contraction (bronchoconstriction)

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

What is the effect of Adenylate Cyclase/cAMP activation in airway tissues?

A

A decrease in intracellular calcium, resulting in dilation (bronchodilation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the effect of vasoactive intestinal peptide in airway tissues?

A

Increase NO production, which stimulates cGMP and results in bronchodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

There are three classes of pulmonary medications:

A
  1. Direct acting bronchodilators
  2. Anti-Inflammatories
  3. Methylxanthines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the two types of direct-acting bronchodilators?

A

Beta-2 Agonists
Anticholinergics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What anti-inflammatory drugs are used for pulmonary disease?

A

Corticosteroids
Cromolyn
Leukotriene Modifiers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the MOA of theophylline?

A

Its a phosphodiesterase inhibitor, which increases cAMP and decreases intracellular calcium

It also increases endogenous catecholamine release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the most sensitive test for small airway obstructive disease?

A

Forced expiratory flow at 25-75% vital capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a normal FEV1?

A

> 80% of predicted value (which changes with age)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a forced vital capacity

A

The volume of air that can be exhaled after a maximal inhalation

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

What does the FEV1/FVC ratio measure?

A

Compares the air expired in 1 second to the total volume of air expired.

Helps in deciphering restrictive vs. obstructive disease.

If there’s restriction, they’ll have a normal ratio. There’s less air going out because there’s less air coming in, but everything inhaled is exhaled.

If there’s obstruction, the ratio will be < 70%, meaning they’re getting a normal amount in but not all of that is being exhaled.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the MMEF?

A

Mid Maximal Expiratory Flow Rate… another name for Forced Expiratory Flow at 25-75% of VC

Reduced with obstructive disease
Normal with restrictive disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the best pulmonary test of endurance?

A

Maximum voluntary ventilation (MVV)

Maximum volume that can be inhaled and exhaled over 1 minute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does DLCO measure?

A

The ability of the alveolocapillary membrane to exchange gas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

DLCO measurement is based on what law?

A

Fick’s law of diffusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a normal DLCO?

A

17-25 ml/min/mmHg

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

What patient subsets are particularly at risk for postop pulmonary complications?

A

COPD
Elderly
CHF
Smoking

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

What procedures carry a higher risk of postop pulmonary complciations?

A

Surgery > 2 hrs
General Anesthesia
Aortic Surgery
Abdominal Surgery
Neuro and peripheral vascular surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How does a patient have to quit smoking in order to have decreased risk of postop pulmonary complications?

A

At least 6 weeks
Short term cessation will improve P50, but not complication rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are some risk reduction strategies to prevent postop pulmonary complications?
Alveolar recruitment maneuvers and PEEP Bronchodilators/Steroids for obstructive disorders Treat active infections Consider not doing a general anesthetic Teach the patient pulmonary recruitment maneuvers
26
What lab value indicates a high risk for postop pulmonary problems?
Albumin < 3.5, because it indicates poor nutritional status
27
What are alveolar recruitment maneuvers?
Peak airway pressure of 30cmH20 is required to reopen atelectic regions Increase PIP to 40 for 8 seconds
28
If a patient with asthmas bronchospasms immediately following tracheal intubation, what is the most likely cause?
Vagal stimulation
29
What is the most common ABG finding during an asthma attack?
Respiratory alkalosis from increased Mv
30
What are some histamine releasing drugs that should be avoided in patients with asthma?
Morphine Meperidine Succinylcholine Atracurium
31
What would a chest x ray look like in a patient with an asthma attack?
Hyperinflated lungs with diaphragmatic flattening
32
Should an HME be used in patients with asthma?
It may benefit patients with exercise-induced asthma
33
What dose of IV lidocaine suppresses airway reflexes?
1-1.5 mg/kg
34
Why can't asthmatics have hemabate?
It mimics the actions of pro-inflammatory prostaglandins
35
What are the clinical features of chronic bronchitis?
hypertrophied mucus glands chronic inflammation
36
What are the clinical features of emphysema?
Enlargement and destruction of the airways DISTAL TO the terminal bronchioles
37
In patients with severe COPD, what FiO2 should be used?
The least amount required to maintain SpO2 between 88 and 92%
38
What does alpha 1 antitrypsin do?
Its an enzyme produced by the liver that inhibits alveolar elastase (which breaks down elastic tissue)
39
Does supplemental oxygen suppress hypoxic drive in patients with COPD?
No - but it can cause oxygen-induced hypercapnea It can cause inhibition of HPV AND an increase in hypercarbia because of the Haldane effect
40
Should you use nitrous in patients with COPD?
Meh. It rupture pulmonary blebs and cause a pneumothorax
41
What are the highest risk factors for aspiration?
Pregnancy Trauma Emergency Surgery GI Obstruction
42
What is Mendelson's Syndrome?
Aspiration Pneumonitis
43
What are the S/S of aspiration pneumonia?
Hypoxemia (hallmark sign) Dyspnea Tachypnea Cyanosis
44
How long should patients who are suspected of aspiration be watched in PACU?
At least 2 hours. If they look good at that point and have a clean CXR they can go home.
45
What percentage of people who aspirate get sick?
60% remain asymptomatic 20% require support 15% require ventilation > 6 hours 5% die
46
What are the most common pathogens responsible for VAP?
Pseudomonas and Staph Aureus
47
What are the hallmark characteristics of a tension pneumothorax?
Hypoxemia Increased airway pressures Tachycardia Hypotension Elevated CVP
47
POCUS on a patient with a Pneumo will show:
absent sliding and absence of comet tails
48
What causes a closed pneumothorax?
A defect in the pulmonary tree or lung tissue itself, NOT the chest wall
49
What causes a chylothorax?
The thoracic duct empties lymph into the left subclavian vein. Injury to the duct during CL insertion can cause chylothorax.
50
What is the treatment for VAE?
Administering 100% FiO2 Flooding the surgical field Discontinuing insufflation Employing the durant maneuver
51
What is the Durant Maneuver?
Left lateral decubitus position
52
Which drugs notoriously increase PVR?
Nitrous Oxide Ketamine Desflurane
53
What drugs notoriously decrease PVR?
Nitric Oxide Nitroglycerin PDEs PGE1 and PGI2 Ca Channel blockers ACE Inhibitors
54
What ventilator settings decrease PVR?
Spontaneous breathing Preventing coughing/straining
55
What ventilator setting increase PVR?
PEEP Any degree of atelectasis
56
What effect does CO2 have on PVR?
Hypercarbia INCREASES PVR Hypocarbia DECREASES PVR
57
Which is better in patients with pHTN: epidural or spinal?
Epidural. They're very preload dependent.
58
What is the half life of CO?
4-6 hours on RA 60-90 minutes on 100%
59
When is hyperbaric oxygen indicated for CO poisoning?
If CoHgb exceeds 25% or the patient is symptomatic
60
What is the affinity for Hgb in CO vs O2?
200x higher in CO
61
In patients with CO poisoning, 100% O2 should be continued until:
the CoHgb is less than 5%
62
What are strong indicators that mechanical ventilation is needed?
1. Vital Capacity < 15ml/kg 2. Insp Force < 25 3. PaO2 < 200 on 100% 4. A-a gradient > 450 on 100% 5. PaCo2 > 60 6. RR > 40 or < 6
63
Which drugs can be given down the ETT?
NAVEL Narcan Atropine Vasopressin Epinephrine Lidocaine
64
What are the best predictors of postoperative pulmonary complications for patients undergoing OLV?
FEV1 < 40% predicted DLCO , 40% predicted VO2 max < 15 ml/kg/min
65
When should split lung V/Q function testing be performed?
When the predictors for poor postop pulmonary performance are present
66
What are absolute indications for OLV?
Infection Massive Hemorrhage Bronchopleural Fistula
67
What are relative indications for OLV?
Improved surgical exposure Pulmonary Edema Severe hypoxemia due to lung disease
68
When should a R sided DLT be used?
L Main bronchus has distorted anatomy (tumor, TAA) L Pneumonectomy, LL transplant, L sleeve resection,
69
What is the ideal DLT size in women? In Men?
Female 35-37 Male 39-41
70
At what age can DLTs be used in children?
Should not be used in children under 8. Should use a bronchial blocker or single lumen tube in children less than 8.
71
What is the average insertion depth for a DLT in females? In Males?
Females 27 Males 29
72
What is the appropriate size of DLT in a child 8-9 years old?
26
73
What is the appropriate size of DLT in a child 10+?
28 or 32
74
What structures should you visualize when checking DLT placement fiberoptically?
1. The Trachial Lumen 2. The blue of the bronchial cuff should just barely be visible 3. There should be three take offs on the R bronchus 4. There should be two take offs on the L bronchus
75
What are the steps to evaluating a L sided DLT?
1. Inflate both cuffs and clamp the tracheal, then ventilate the bronchial 2. Keep both cuffs inflated and clamp the bronchial, then ventilate the tracheal 3. Deflate the bronchial cuff and keep in clamped then ventilate the tracheal
76
What should you do if a patient becomes hypoxemic during OLV?
1. Administer 100% 2. Check position fiberoptically 3. Rule out physiologica causes (CO, mucus, bronchospasm) 4. Apply CPAP 2-10 to non-dependent lung OR insufflate oxygen through a suction catheter 5. Apply PEEP to the dependent lung and CPAP to non-dependent 5. Consider converting to a TIVA
77
Is hypoxemia more common during OLV on the right or left lung?
Right Lung The left lung is smaller, so there's less surface area for gas exchange
78
What is an absolute contraindication of mediastinoscopy?
A previous mediastinoscopy, due to scarring
79
What are the most common complications of mediastinoscopy?
Hemorrhage and Pneumothorax
80
What disease often accompanies oat cell carcinoma?
Eaton-Lambert Syndrome
81
Trace the vascular anatomy from the heart to the brain
82
For a mediastinoscopy, where should the art line and SpO2 probe be placed?
RUE, just like for babies If the innominate artery is compressed, your art line and SpO2 waveform will dampen
83
For a mediastinoscopy, where should the NIBP cuff be placed?
On the Left. You don't want to confuse your cuff going off with compression of the innominate artery
84
What is the ideal placement for large PIV in a mediastinoscopy?
The lower extremities. If it's in the upper extremities, there's a good chance blood transfused will pass through one of the damaged vessels
85
What are the three stages of ARDS?
Exudative Proliferative Fibrotic
86
What are the four pathophysiologic processes of ARDS?
1. Protein rich pulmonary edema 2. Loss of surfactant 3. Hyaline membrane formation 4. Possible fibrotic injury

Apex (46 decks)

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