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Apex Review > Respiratory pathophysiology 2 > Flashcards

Respiratory pathophysiology 2 Flashcards

1
Q

A forced vital capacity is the

A

volume of air that can be exhaled after a maximal inhalation

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2
Q

What are the normal values of forced vital capacity?

A

male: 4.8 L
female: 3.7 L

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3
Q

What is the forced expiratory volume?

A

volume of air that can be exhaled after a maximal inhalation in 1 second

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4
Q

Forced expiratory volume depends on

A

the patient’s effort

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5
Q

Forced expiratory volume declines

A

with age (predicted values take this into account)

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6
Q

FEV1 to FVC ratio compares

A

volume of air expired in 1 second and total volume of air expired

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7
Q

FEV1/FVC ratio is useful in diagnosis of

A

obstructive vs. restrictive disease

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8
Q

FEV1/FVC ratio is __________ with obstructive disease & ________ with restrictive disease

A

<70% suggest obstructive disease; usually normal

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9
Q

The forced expiratory flow at 25-75% vital capacity is ____________ with obstructive disease & ___________ with restrictive disease

A

usually reduced; usually normal

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10
Q

The maximum voluntary ventilation is the

A

maximum volume of air that can be inhaled and exhaled over the course of 1 minute

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11
Q

The best test of endurance is the

A

maximum voluntary ventilation

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12
Q

Normal maximum voluntary ventilation values for males & females are

A

male: 140-180 L
female: 80-120 L

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13
Q

Flow-volume loops allow us to

A

differentiate between obstructive & restrictive respiratory diseases

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14
Q

The patient begins inhalation from

A

residual volume and stops when they achieve total lung capacity

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15
Q

Inhalation produces a waveform that moves from

A

right to left with a negative deflection

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16
Q

Exhalation occurs when the patient exhales back to

A

residual volume

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17
Q

Exhalation produces a waveform that moves from

A

left to right with a positive deflection

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18
Q

________ is the width of the loop

A

Vital capacity

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19
Q

All of the following are independent risk factors for postoperative pulmonary complications EXCEPT:
a. age >65 years
b. chronic obstructive pulmonary disease
c. congestive heart failure
d. asthma

A

d. asthma

20
Q

Independent risk factors for postoperative pulmonary complications can be categorized as

A

patient-related
procedure-related
diagnostic testing

21
Q

Patient examples of risk factors for postoperative pulmonary complications include

A

old age (>60 years), COPD, CHF, smoking, ASA >2

22
Q

Procedure examples of risk factors for postoperative pulmonary complications include

A

surgery >2 hrs, GA, aortic or abdominal surgery

23
Q

Diagnostic examples of risk factors for postoperative pulmonary complications include

A

albumin <3.5 g/dL (indicates poor nutritional status)

24
Q

Short term benefits of smoking cessation include

A

a reduction in carboxyhemoglobin (improved P50), but this does not reduce the risk of postoperative pulmonary complications

25
Q

Risk reduction strategies for postoperative pulmonary complications include:

A

smoking cessation (at least 6 weeks)
consider anesthetic options besides GA
teach patient to use pulmonary recruitment maneuvers
treat active infections (prophylaxis is not indicated)
treat expiratory airflow obstruction with bronchodilators and corticosteroids
employ alveolar recruitment maneuvers (ARMs)+ PEEP

26
Q

Factors that have NOT been shown to increase risk of postoperative pulmonary complications for non-thoracic surgery include:

A

mild/moderate asthma
ABG analysis
pulmonary function testing

27
Q

Short term effects of smoking cessation include

A

carbon monoxide t1/2= 4-6 hrs
P50 returns to near normal in 12 hours

28
Q

Return of pulmonary function after smoking takes at least 6 weeks. This includes:

A

airway function
mucociliary clearance
sputum production
pulmonary immune function
hepatic enzyme induction also subsides after 6 weeks

29
Q

A peak airway pressure of _______ is required for initial reopening of the atelectatic regions.

A

30 cm H2O

30
Q

Increasing the PIP to ________________________ appears to reverse anesthesia-induced atelectasis almost completely

A

40 cm H2O for 8 seconds

31
Q

Postoperative strategies to reduce postoperative pulmonary complications include

A

utilize effective analgesia (intercostal nerve block, neuraxial opioids, PCA)
use pulmonary recruitment maneuvers

32
Q

A patient with severe kyphoscoliosis is expected to have a reduced: (select 2)
a. FEV1/FVC ratio
b. FRC
c. FEF 25-75%
D. FEV1

A

B. FRC
D. FEV1

33
Q

Obstructive disease is characterized by

A

small airway obstruction and increased resistance to expiratory flow
getting air out is the problem

34
Q

Restrictive disease is characterized by a

A

proportionate reduction in all of the lung volumes along with poor compliance
small lung volumes are the problem

35
Q

Patients with obstructive disease have a decreased

A

FEV1/FVC

36
Q

Patients with obstructive disease can have a normal or decreased

A

FEV1 & FVC

37
Q

Patients with restrictive disease have a decreased

A

FEV1 & FVC

38
Q

Patients with restrictive disease have a ___________ FEV1/FVC & FEF 25-75%

A

normal

39
Q

The spirometry waveform of an obstructive disease looks like:

A

the expiratory limb has a concave shape

40
Q

The spirometry waveform of a restrictive disease looks like:

A

the restrictive loop is smaller and right shifted

41
Q

What does a fixed lesion look like on spirometry?

A

the inspiratory and expiratory limbs are flat- someone smashed my ice cream cone & it needs to be “fixed”

42
Q

Examples of a fixed lesion include

A

tracheal stenosis

43
Q

Sometimes can upper airway lesion is a problem during inspiration and expiration. Other times the upper airway lesion is

A

variable and only creates the obstruction during inspiration OR during expiration

44
Q

A ____________ obstruction has obstruction with inspiration.

A

extrathoracic

45
Q

A __________ obstruction has obstruction with expiration

A

intrathoracic

46
Q

A patient with asthma experiences bronchospasm immediately following tracheal intubation. This is MOST likely the result of:
a. mast cell degranulation
b. decreased sympathetic tone
c. histamine release
d. vagal stimulation

A

d. vagal stimulation

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