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SEE 2025 > Respiratory Pathophysiology APEX- Part 2 > Flashcards

Respiratory Pathophysiology APEX- Part 2 Flashcards

1
Q

The __ has the most significant contribution to airflow resistance

A

Radius

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2
Q

The __ nerve supplies PNS innervation to the airway smooth muscle

A

Vagus

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3
Q

What receptor of the airway causes bronchoconstriction?

A

M3

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4
Q

What do mast cells do

A

Massive bronchoconstriction
Mast - Bronchoconstrict

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5
Q

What is the role of non-cholinergic C-fibers?

A

Bronchoconstriction

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6
Q

Pathway of constriction

A

M3-PLC-IP3-LEUKOTREE- Increase CA

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7
Q

Pathway of bronchodilation

A

B2-AC-CAMP-relax- Decrease CA
Non cholinergic PNS- NO-cGMP relax

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8
Q

What is the role of NO?

A

Potent smooth muscle relaxant
Stimulates cGMP- more bronchodilation

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9
Q

side effects of B2 agonists

A

Tachycardia
Hyperglycemia
Hypokalemia
Tremor

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10
Q

Side effects of anticholinergics

A

Dry mouth
blurry vision
Cough
Urinary retention

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11
Q

Steroid side effects

A

Dysphonia
Myopathy of laryngeal muscles
Oropharyngeal candidiasis
Possible adrenal suppression

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12
Q

Example of a methylxanthine

A

Theophylline

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13
Q

Theophylline side effects

A

> 20- N/v/headache
30- Seizure, tachydysrhythmias, CHF

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14
Q

MOA of methylxanthines

A

Inhibits PDE- which increases cAMP
Increases catecholamine release
Inhibits adenosine receptors

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15
Q

Which receptor do anticholinergics work at?

A

M3

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16
Q

MOA of cromolyn

A

Mast cell stabilizer

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17
Q

MOA of Leukotriene modifiers

A

Inhibits 5-lipoxygenase- decreases leukotriene synthesis

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18
Q

Most sensitive indicator of small airway disease?

A

FEF 25-75 aka MMEF

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19
Q

Normal value of FEV1

A

> 80%

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20
Q

Normal FEV1/FVC ratio?

A

> 80%

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21
Q

DLCO normal value

A

17-25 ml/min/mmHg

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22
Q

What is the best test of endurance?

A

MVV
Maximum voluntary ventilation

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23
Q

Which test can diagnose OLD vs RLD? How?

A

FEV1-FVC ratio
Normal with RLD, <70% with OLD

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24
Q

FEV25-75 is usually __ in obstructive airway disease?

A

Reduced

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25
Q

FEV25-75 is usually __ in restrictive airway disease?

A

Normal

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26
Q

Predictors of PPC? (patient specific)

A

Age >60
COPD
CHF
Smoker (>40 pack years especially)

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27
Q

Surgery specific predictors of PPC?

A

Surgical site- aortic, thoracic, upper abdomen, neuro, vascular, emergency
Procedure >2 hours
GA

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28
Q

Diagnostic tests for PPC

A

Albumin <3.5

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29
Q

What doesnt increase risk of PPC?

A

ABG analysis
Asthma (moderate)
PFT

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30
Q

Patient must quit smoking for ___ to see normalization of pulmonary function

A

6 weeks

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31
Q

How does smoking affect the lungs?

A

Decreased mucociliary clearance
Airway hyperreactivity
Reduced immune function

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32
Q

How does smoking affect the CV system?

A

CV disease risk factor
Decreases DO2
Catecholamine release
Coronary vasoconstriction
Decreased exercise tolerance

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33
Q

Smoking will impair ___ healing

A

Wound

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34
Q

How to perform an ARM

A

Increase PIP to 40 for 8 seconds, then apply PEEP

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35
Q

Define Atopy

A

Hyper-allergic

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36
Q

Greatest risk factor for developing asthma?

A

Atopy- hyper-allergic

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37
Q

Most common ABG with asthma

A

Respiratory alkalosis from tachypnea
Hypocarbia

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38
Q

What are the histamine releasing drugs that are bad for asthmatic

A

Sux
Atracurium
Morphine
Meperdine

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39
Q

What drugs can provoke asthma?

A

ASA
NSAIDS
B agonists
Sulfits

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40
Q

What would the EKG of an asthmatic show?

A

RV strain with R-axis deviation

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41
Q

What would a CXR of an asthmatic show?

A

Hyperinflated lungs with a flattened diaphragm

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42
Q

Toradol can __ airway resistance

A

Increase
Avoid in asthmatics

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43
Q

Which beta blocker is best for asthmatics?

A

Esmolol bc short half life

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44
Q

Carboprost, the uterotonic(?), can cause __

A

bronchoconstriction in ashtmatics

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45
Q

Bronchospasm will show what on an ETCO2 waveform?

A

Increased Alpha angle- sharkfin
Same as bronchospasm

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46
Q

____ causes panlobular empyhsema
How?

A

Alpha 1 antitrypsin deficiency
Causes increased protease which degrades pulmonary connective tissue

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47
Q

What is the treatment for alpha 1 antitrypsin deficiency?

A

Liver transplant

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48
Q

Bronchitis is associated with __

A

Hypertrophied mucus glands and chronic inflammation
Cough and sputum

A lot of RBC

49
Q

Emphysema is associated with __

A

Enlargement and destruction of lower airways

50
Q

Etiologies of COPD

A

Smoking
Alpha 1 antitrypsin deficiency
Environmental pollutants
Respiratory infections

51
Q

Where is alpha 1 antitrypsin produced?

52
Q

When can you not consider regional anesthesia for COPD patients?

A

If sensory block is required over T6

53
Q

Can you consider N2O for COPD patients?

A

No, rupture pulmonary blebs will lead to PTX

54
Q

Which block isn’t the best for COPD patients?

A

Interscalene

55
Q

Do you use PEEP for COPD patients?

A

Yes, they help alveoli

56
Q

Examples of Restrictive lung disease

A

Sarcoidosis
Flash edema
Flail chest
Pulmonary fibrosis (amiodarone induced)
Obesity/ pregnancy/ ascites
Ankylosing spondylitis
Pleural effusion

57
Q

Examples of obstructive lung disease

A

COPD
Asthma
CF- creates mucus plus and cant exhale

58
Q

What happens to FEV1, FVC, and the ratio in RLD?

A

Decreased <70%
Decreased <70%
Normal

59
Q

RLD ventilatory strategies

A

Low Vt- 6ml/kg
High RR
1:1 I:E

60
Q

OLD ventilatory strategies

A

Medium Vt- 6-8
Higher I:E- 1:3
PEEP but stay alert for dynamic hyperinflation

61
Q

Diseases of the chest wall- RLD

A

Kypho
AS
Flail chest
PTX
Pleural effusion
Mediastinal mass
Muscular dystrophy
Guillian barre
Spinal cord transection

62
Q

Acute intrinsic RLD

A

Flash edema
Cocaine OD
Reversal of opioid OD- narcan
Reexpansion of collapsed lung
Upper airway obstruction- flash edema?
Aspiration

63
Q

How to reduce the incidence of VAP

A

Oral care
Reduce vent time
Limit sedation
Handwashing
Subglottic suction
HOB >30

64
Q

Mendelson syndrome

A

Gastric PH <2.5
Gastric volume >25ml

65
Q

Treatment for aspiration

A

Left head tilt
Suction
Secure airway
PEEP
Head down

66
Q

When are PPIs useful?

A

To prevent aspiration pneumonitis- but not VAP

67
Q

Patients who aspirate can go home unless they experience the following within 2 hours:

A

New cough
Aa >300
SPO2 drops by 10
CXR of pulmonary injury

68
Q

Most common bacterias of VAP

A

Pseudomonas
Staph Aureus

69
Q

Where to do needle chest decompression after a tension pneumo

A

2 ICS Mid clavicular
4th IC anterior axillary

70
Q

Tension pneumo causes a shift to the __lateral side

A

Contralateral

71
Q

Thoracotomy indications

A

1L drainage or 200ml/hr
Large air leak
White lung on CXR

72
Q

When can a patient have VATS instead of thoracotomy?

A

Hemodynamically stable
<150 ml/hr

73
Q

VAE risk positions

A

Sitting
Supine
Prone
Lateral- the treatment

74
Q

VAE will __ ETCO2

75
Q

Signs of VAE

A

Milwheel on dopper
Air on TEE
Low etco2
HOTN
Hypoxia

76
Q

Treatment of VAE in order

A

fio2 1.0
Flood with saline
Decompress stomach
Left lateral
Aspirate from CVC
Pressors

77
Q

PDE inhibitors

A

Methlyxanthines- theophylline, viagara, cilais
Vasodilaiton
Bronchodilation

78
Q

Which reduces PVR?

A

Increased PaO2, hypocarbia (opposite of increased PVR)
Nitric oxide
Hyperventilation decreases CO2 and thus, blood volume
Nitroglycerine - see below
Antihypertensives- PDE inhibitors, ACE inhibitors, CCB, NTG

79
Q

What increases PVR?

A

PEEP
Acidosis
N2O
Hypothermia
Hypoxia/ hypercarbia
Desflurane
Ketamine

80
Q

Pulmonary hypertension is mean PAP > ___

81
Q

Causes of pulmonary hypertension

A

COPD
LV dysfunction
MV disease
Hypoxemia/ hypercarbia

82
Q

PVR formula and reference range

A

mean PAP- PAOP
/
CO
x 80
200 dynes/s/cm^5

83
Q

What agents produce CO the most when dessicated?

A

Des, iso, then Sevo

84
Q

CO has _x times higher affinity for HGB than oxygen

85
Q

What equipment is required to diagnose carboxyhemoglobinemia?

86
Q

Presentation of CO poisoning

A

Cherry red appearance

87
Q

Treatment for CO poisoning

A

100% oxygen will reduce 1/2 life to one hour (so 5 hours in total to rid CO)
Which is until CoHGB is <5% for 5-6 hours

88
Q

Hyperabaric oxygen after CO poison is indicated if the CoHGB exceeds _%

89
Q

Soda lime is hydrated to _%

90
Q

When will Sevo cause compound A?

A

Dessicated soda lime
Minimal CO2 production, but high Compound A!

91
Q

What is the risk of Compound A?

A

Fire!
+ Liver damage ?

92
Q

Indications for intubation:
Vital capacity
IF
PaO2
Aa
PaCO2
RR

A

<15
<25
<200
>450
>60
>40 or <6

93
Q

NAVEL

A

Narcan
Atropine
Vaso
Epi
Lido

94
Q

Reference range for:
Vital capacity
IF
PaO2
Aa
PaCO2
RR

A

75 ml/kg
75 cm H2O
>60
5-15
35-45
10-25

95
Q

Absolute indications for OLV

A

Infection control of one lung
Bronchopleural fistula- similar to a PTX? and needs to be fixed
Massive hemmorage of one lung
Large unilateral cyst
Life threatening hypoxemia due to lung disease of one lung

96
Q

When would a right sided DLT be indicated?

A

Left sided distorted anatomy- tumor, TAA
Left sides procedures- L pneumonectomy, Left sleeve resection

97
Q

DLT sizes and depth

A

Female- 35-37 (160cm cut off)- 27cm
Male- 39-41 (170cm cut off)- 29cm

98
Q

DLT is not to be used in ages under _
What to do instead?

A

8

Bronchial blocker
Mainsteming the ETT into the preferred lung

99
Q

PPC predictors (PFTs)

A

DLCO <40%
FEV1 <40%
VO2 Max < 15ml/kg/min

100
Q

Cuff volume for bronchial vs tracheal lumen

A

Bronchial- 1ml
Tracheal- 10

101
Q

Normal VO2 max

A

Men- 40 ml/kg/min
Women- 30 ml/kg/min

102
Q

During anesthesia in the lateral position, which lung is best perfused vs best ventilated?

A

Dependent- best perfused
Nondependent- best ventilated
VQ mismatch!

103
Q

Stepwise approach to hypoxemia during OLV

A

100% fio2
Check position of tube
CPAP non dependent luung
PEEP dependent lung
Inflate nondependent lung

104
Q

Ventilation/ anesthetic strategies for OLV

A

Fio2- 100%
Vt- 6ml/kg
RR-15 to maintain normal EtCO2
ARM before initiating OLV
Consider TIVA to maintain HPV

105
Q

HPV minimizes _

106
Q

The bronchial blocker cannot:

A

Prevent contamination
Ventilate the isolated lung
Suction the ventilated lung

107
Q

Can the bronchial blocker be used intranasally?

108
Q

Can the bronchial blocker insufflate O2 into the isolated lung? What about suction?

A

Yes
Can suction AIR, but not secretions

109
Q

Most serious complications of mediastinoscopy

A

1- Hemorrhage (aorta, vena cava near scope insertion site)
2- Pneuomthorax- R side

110
Q

Absolute contraindication to mediastinoscopy

A

Previous mediastinoscopy! You can only have 1 done

111
Q

When doing a mediastinoscopy, where to place vital sign measurements and why?

A

Pulse ox + A-line - right hand
BP cuff- left arm
Will assess innominate artery (right side) for occlusion

112
Q

Post op rules for tracheal resection

A

Keep neck flexed for several days to reduce tension on incision
If reintubation is needed, use Flexible FOB

113
Q

Steps for tracheal resection intubation

A

Intubate above lesion
Makes incision
Second ETT below lesion into L main
Suture anastomosis
Remove second ETT, then advance first ETT into L main

114
Q

ARDS ventilation strategies

A

Low vt- 4-6ml/kg
PEEP
PCV
SPO2 goal- 88-95- keep below 50% if possible- high O2= oxidative stress
Plateau pressure <30

115
Q

ARDS berlin definition

A

<1 week onset
CXR- bilateral opacities
NOT explained by cardiac failure
PF 100-300 for severity of mild, moderate, and severe

116
Q

Causes of ARDS

A

PNA most common intrapulmonary
Sepsis most common extra pulmonary
Covid
Aspiration
Drowing
Smoke injury
Trali/ TACO
Burns

117
Q

FRC is _ in RLD

SEE 2025 (10 decks)

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