Respiratory pathophysiology 3

Question 1

Asthma is defined by an

Answer 1

acute, reversible airway obstruction that is accompanied by chronic airway inflammation and bronchial hyperreactivity

Question 2

____________ is the greatest risk factor for developing asthma

Answer 2

Atopy (the condition of being “hyper-allergic”)

Question 3

Asthma has a __________ component

Answer 3

reversible!- bronchodilator therapy helps to improve

Question 4

With asthma, ______________ are reduced but improve following bronchodilator therapy

Answer 4

FEV1
FEV1/FVC
FEF 25-75%

Question 5

The most common ABG finding with asthma is

Answer 5

respiratory alkalosis with hypocarbia

Question 6

With asthma, an elevated PaCO2 suggests

Answer 6

air trapping
respiratory muscle fatigue
impending respiratory failure

Question 7

Key signs and symptoms of asthma include

Answer 7

wheezing
dyspnea
chest discomfort and/or tightness
productive or non-productive cough
prolonged expiratory phase
eosinophilia

Question 8

What kind of extubation is preferred for asthmatics?

Answer 8

deep if not contraindicated

Question 9

Ways to avoid triggering asthma include:

Answer 9

suppressing airway reflexes during airway instrumentation (consider an LMA or regional technique instead of tracheal intubation if possible)

Question 10

What types of drugs should be avoided with asthmatics?

Answer 10

non-selective beta blockers (use beta 1 selective agents instead)
avoid histamine-releasing drugs (succinylcholine, atracurium, morphine, meperidine)

Question 11

What should be done intraoperatively for asthmatics?

Answer 11

limit inspiratory time
prolong expiratory time
tolerate moderate permissive hypercapnia

Question 12

Anesthetic agents that promote bronchodilation include

Answer 12

sevo
iso
ketamine
propofol
and lidocaine (IV or tracheal)

Question 13

Stimuli that provoke s/sx of asthma include

Answer 13

allergens- environmental
drugs- aspirin, NSAIDs, beta antagonists, sulfites
infection-resp. virus
stress- vagal stimulation, cold air
exercise- usually following physical activity

Question 14

With asthma, tachypnea and hyperventilation are the result of __________________ NOT ___________.

Answer 14

neural reflexes; NOT hypoxemia

Question 15

A _________ retains airway humidity and may benefit patients with exercise-induced asthma.

Answer 15

heat-moisture exchanger

Question 16

___________ can increase airway resistance and should be avoided in patients with aspirin-intolerant asthma.

Answer 16

Ketorolac

Question 17

This obstetric drug can cause bronchoconstriction in asthmatic patients

Answer 17

Carboprost (hemabate)

Question 18

____________ reduces the viscosity of airway secretions

Answer 18

Intravenous hydration

Question 19

Although anticholinesterases could precipitate bronchospasm, co-administration of ______ negates the risk.

Answer 19

anticholinergics

Question 20

_________ is the best choice beta blocker in asthmatics

Answer 20

esmolol because of its short 1/2 life and beta-1 selectivity

Question 21

Presynaptic H2 receptor stimulation reduces ________

Answer 21

histamine release; can cause bronchospasm but risk is low

Question 22

Which drug is LEAST likely to be effective in relieving symptoms of acute bronchospasm?
a. ketamine 1 mg/kg IV
b. epinephrine 1 mcg/kg IV
c. hydrocortisone 2 mg/kg IV
d. lidocaine 1.5 mg/kg IV

Answer 22

c. hydrocortisone 2 mg/kg- won’t help in acute phase b/c it takes several hours to take effect

Question 23

Not all wheezing is asthma, so you must consider other etiologies in your differential diagnosis including

Answer 23

a kinked ETT
end-bronchial intubation
& pulmonary aspiration
pneumothorax
pulmonary edema
pulmonary embolus
light anesthesia leads to coughing and straining and reduced FRC

Question 24

Intraoperative bronchospasm presents as

Answer 24

wheezing
decreased breath sounds
increased peak inspiratory pressure (decreased dynamic compliance)
increased alpha angle on the EtCO2 waveform

Question 25

Treatment for acute bronchospasm includes

Answer 25

100% FiO2 deepen anesthetic short-acting inhaled beta 2 agonist inhaled ipratropium epinephrine 1 mcg/kg IV hydrocortisone 2-4 mg/kg IV aminophylline helium-oxygen gas mixture

Question 26

Mechanical obstruction of ETT can be a result of

Answer 26

kinking patient biting down secretions cuff overinflation

Question 27

_______________ is NOT used in the treatment of acute bronchospasm.

Answer 27

Montelukast

Question 28

Alpha-1 antitrypsin deficiency: (select 2) a. increases the risk of bronchospasm b. causes panlobular emphysema c. can be treated with IgG d. is the most common metabolic disease affecting the liver

Answer 28

b. causes panlobular emphysema d. is the most common metabolic disease affecting the liver

Question 29

COPD is characterized by a reduction in

Answer 29

maximal expiratory flow and a slower forced emptying of the lungs

Question 30

Unlike asthma, air flow obstruction with COPD is

Answer 30

not fully reversible

Question 31

The name COPD is really an umbrella term for

Answer 31

chronic bronchitis and emphysema

Question 32

Chronic bronchitis is associated with

Answer 32

hypertrophied bronchial mucus glands and chronic inflammation

Question 33

Emphysema is associated with

Answer 33

enlargement and destruction of the airways distal to the terminal bronchioles

Question 34

Etiologies of COPD include

Answer 34

smoking respiratory infection exposure to environmental pollutants such as coal mining, gold mining, and textile industries alpha 1 antitrypsin deficiency

Question 35

Inability to fully exhale leads to

Answer 35

gas trapping (increased residual volume)

Question 36

Chronically elevated PaCO2 causes

Answer 36

respiratory acidosis

Question 37

With COPD, the kidneys reabsorb bicarbonate which provides a

Answer 37

compensatory metabolic alkalosis

Question 38

Administering supplemental oxygen to the patient with severe COPD does

Answer 38

not inhibit the "hypoxic drive"

Question 39

Administering supplemental oxygen to the patient with severe COPD can cause

Answer 39

oxygen-induced hypercapnia due to inhibition of hypoxic pulmonary vasoconstriction The Haldane effect

Question 40

To minimize the risk of oxygen-induced hypercapnia in the patient with severe COPD, you should titrate the FiO2 to maintain the SaO2 between

Answer 40

88-92%

Question 41

Common findings in patients with COPD include

Answer 41

flattened diaphragm increased AP diameter pulmonary bullae increased work of breathing

Question 42

______________ removes over distended tissue and allows normal lung tissue to function in a more regular way for patients with COPD

Answer 42

Lung reduction surgery

Question 43

Chronic bronchitis is defined by the presence of

Answer 43

cough and sputum production for more than three months for two consecutive years

Question 44

The common cause of chronic bronchitis is

Answer 44

cigarette smoking

Question 45

What happens to the heart in chronic bronchitis?

Answer 45

left heart function is normal (normal PAOP) a weak right heart creates a back pressure on the liver--> liver congestion and ascites

Question 46

_________________ is more efficacious than any drug in terms of improving pulmonary hypertension and preventing erythrocytosis in chronic bronchitis.

Answer 46

Oxygen therapy

Question 47

With chronic bronchitis, RBCs are

Answer 47

overproduced to compensate for V/Q mismatch and hypoxemia leads to increased blood viscosity and myocardial work

Question 48

With chronic bronchitis, chronic hypoxemia and hypercarbia increase PVR leading to

Answer 48

pulmonary hypertension--> RV strain--> cor pulmonale

Question 49

Emphysema is associated with

Answer 49

enlargement and destruction of the airways distal to the terminal bronchioles

Question 50

Emphysema results in

Answer 50

increased dead space & destruction of the pulmonary capillary bed leading to pHTN

Question 51

_______ can cause emphysema

Answer 51

Alpha-1 antitrypsin deficeincy

Question 52

The patient with emphysema generally has a normal or slightly reduced

Answer 52

PaO2 PaCO2 is usually normal or decreased (as a result of hyperventilation)

Question 53

Late in emphysema, hypoxemia and hypercarbia further

Answer 53

increase PVR leading to RHF

Question 54

Alpha 1 antitrypsin is an enzyme produced by

Answer 54

the liver

Question 55

Alpha-1 antitrypsin deficiency is a disease where

Answer 55

an abnormal variant of the enzyme is produced

Question 56

Alpha 1 antitryspin deficiency allows a relative overactivity of

Answer 56

alveolar elastase activity resulting in destruction of pulmonary connective tissue and the development of panlobular emphysema

Question 57

What spirometry values are increased in COPD?

Answer 57

RV, FRC, TLC

Question 58

What spirometry values are decreased in COPD?

Answer 58

FEV1, FEV1/FVC ratio, FEF 25-75%

Question 59

An FEV1/FVC ratio of <70% after bronchodilator therapy is diagnostic of

Answer 59

COPD