Unit 1 (Respiratory) - Respiratory Pathophysiology

Question 1

What has the most significant contribution to airflow resistance?

Answer 1

The radius of the airway

Question 2

What physiologic systems determine airway diameter?

Answer 2

1. PNS (Bronchoconstriction)
2. Mast cells & non-cholinergic c-fibers (Bronchoconstriction)
3. Non-cholinergic PNS - Bronchodilation
4. SNS (Bronchodilation)

Question 3

What nerve supplies parasympathetic innervation to the airway smooth muscle?

Answer 3

Vagus nerve

Question 4

Coughing, allergy, and infection activate what three things that amplify the inflammatory response?

Answer 4

IgE, cytokines, and complement

Question 5

Activation of the beta-2 receptor turns on the Gs protein, which activates what?

Answer 5

Adenylate cyclase

Question 6

Nitric oxide stimulates what?

Answer 6

cGMP

Question 7

Pulmonary function tests measure what three things?

Answer 7

Static lung volumes, dynamic lung volumes, diffusing capacity

Question 8

How much air the lungs can hold at a single point in time

Answer 8

Static lung volume

Question 9

How quickly air can be moved in and out of the lungs over time

Answer 9

Dynamic lung volume

Question 10

How well the lungs can transfer oxygen in and carbon dioxide out

Answer 10

Diffusing capacity

Question 11

Volume of air that can be exhaled in 1 second
Effort dependent
Declines with age, so predicted value takes age into account

Answer 11

FEV1 (Forced Expiratory Volume in 1 Second)

Question 12

Volume of air that can be exhaled after a deep inhalation
Effort dependent

Answer 12

Forced Vital Capacity (FVC)
Males = 4.8 L
Females = 3.7 L

Question 13

What is a normal value for diffusing capacity?

Answer 13

17-25 mL/min/mmHg

Question 14

True or False: RV cannot be measured with spirometry

Answer 14

TRUE

Question 15

What are patient related risk factors related to postoperative pulmonary complications?

Answer 15

• Age > 60
• ASA III-V
• CHF
• COPD
• Cigarette smoking

Question 16

What are procedure related risk factors related to postoperative pulmonary complications?

Answer 16

Aortic > Thoracic > Upper abdominal = Neuro = Peripheral vascular > Emergency

Duration > 2.5 hours
General anesthesia

Question 17

What is the best way to reverse anesthesia-induced atelectasis?

Answer 17

Alveolar recruitment maneuvers (ARMs)

Question 18

A peak airway pressure of ____________ is required for initial reopening of the atelectatic regions of the alveoli

Answer 18

30 cmH2O

Question 19

Characterized by small airway obstruction and increased resistance to expiratory flow

Answer 19

Obstructive disease

Question 20

Characterized by a proportionate reduction in all of the lung volumes

Answer 20

Restrictive disease

Question 21

Obstructive Disease:
FVC
FEV1
FEV1/FVC Ratio
FEF 25-75%
RV
FRC
TLC

Answer 21

FVC - Normal (Decreased if gas trapping)
FEV1- Normal (Decreased if gas trapping)
FEV1/FVC Ratio - Decreased
FEF 25-75% - Decreased
RV - Normal (Increased if gas trapping)
FRC - Normal (Increased if gas trapping)
TLC - Normal (Increased if gas trapping)

Question 22

Restrictive Disease:
FVC
FEV1
FEV1/FVC Ratio
FEF 25-75%
RV
FRC
TLC

Answer 22

FVC - Decreased
FEV1 - Decreased
FEV1/FVC Ratio - Normal
FEF 25-75% - Normal
RV - Decreased
FRC - Decreased
TLC - Decreased