UBP Book 5

Question 1

When does fetal heart rate variability develop?

Answer 1

25-27 weeks gestation

Question 2

Pre-pneumonectomy assessment: respiratory mechanics

Answer 2

ppo FEV1 = pre-op FEV1 * (1-% functional lung tissue removed/100)

> 40% low risk
< 40% increased risk
< 30% high risk
< 20% unacceptably high risk

Question 3

Pre-pneumonectomy assessment: cardiopulmonary reserve

Answer 3

VO2 max

> 15-20 low risk
< 15 increased risk
< 10 absolute contraindication

Question 4

Pre-pneumonectomy assessment: lung parenchymal function

Answer 4

ppo DLCO = DLCO * (1-% functional lung tissue removed/100)

< 40% increased risk
< 20% unacceptably high risk

Question 5

When to get a V/Q scan pre-pneumonectomy

Answer 5

If pre-op FEV1 or DLCO are <80% or ppoFEV1 <40%

Question 6

Post-pneumonectomy complications

Answer 6

Right heart failure
Cardiac arrhythmias
Cardiac herniation
Hemorrhage
Broncho-pleural fistula
PTX
Respiratory failure
Postpneumonectomy pulmonary edema (PPE)
Renal dysfunction

Question 7

Key components of pre-pneumonectomy evaluation

Answer 7

Respiratory mechanics
Cardiopulmonary reserve
Lung parenchymal function

Question 8

Expected compensation for acute respiratory acidosis

Answer 8

+1 HCO3 for every +10 PaCO2

Question 9

Expected compensation for acute respiratory alkalosis

Answer 9

-2 HCO3 for every -10 PaCO2

Question 10

Expected compensation for chronic respiratory acidosis

Answer 10

+4 HCO3 for every +10 PaCO2

Question 11

Expected compensation for chronic respiratory alkalosis

Answer 11

-5 HCO3 for every -10 PaCO2

Question 12

Expected compensation for metabolic acidosis

Answer 12

PaCO2 decreases by 1.2 x decrease in HCO3

Question 13

Expected compensation for metabolic alkalosis

Answer 13

PaCO2 increases by 0.7 x increase in HCO3

Question 14

Airway fire management

Answer 14

• Stop delivery of all airway gases (disconnect ETT from circuit)
• Simultaneously remove ETT (surgeon can do this)
• Flood surgical field with saline
• Remove debris from airway (sponges, etc)
• Re-establish ventilation via mask (minimize O2 as able)
• Examine ETT for fragments left behind
• Rigid bronch to eval airway for damage/remove debris
• Re-intubate due to risk for delayed airway edema formation
• Delay extubation for a minimum of 24 hrs
• Consider steroid, e.g. dexamethasone

Question 15

MELD score

Answer 15

Cr
Bilirubin
INR

Ranges from 6-40 and used to prioritize organ allocation

Question 16

What is worsening dyspnea in the upright position called?

Answer 16

Platypnea

Question 17

Hepatopulmonary syndrome

Answer 17

Triad of liver disease, decreased oxygenation, and intrapulmonary vascular dilation

Question 18

What is an endoleak?

Answer 18

Failure to completely isolate the aneurysmal sac from arterial blood flow

Question 19

Types of Endoleaks

Answer 19

I = failure to seal graft to aortic wall at proximal or distal site
II = retrograde flow from intercostal arteries fill aneurysmal sac
III = structural failure of the graft
IV = excessive porosity of the graft
V = Endotension (pressurization of sac without identifiable leak)

II and IV are considered benign
I and III require urgent intervention (a/w increased risk of rupture)