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Pathophysiology > Week 5: sleep/restrictive pulm > Flashcards

Week 5: sleep/restrictive pulm Flashcards

1
Q
  1. Question: A patient with interstitial lung disease (ILD) is undergoing a laparoscopic procedure. During surgery, you notice a rapid decrease in compliance and an increase in peak airway pressures. What is the most likely pathophysiological cause of these changes?
A

increased intraabdominal pressure affecting chest wall mechanics

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2
Q
  1. Question: A patient with restrictive lung disease is undergoing a surgical procedure. They exhibit signs of hypoxemia during the operation. What is the primary pathophysiological factor contributing to this condition?
A

V/Q mismatch

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3
Q
  1. Question: A 65-year-old patient with chronic restrictive lung disease is scheduled for elective surgery. Which of the following characteristics is most likely to be observed in this patient?
A

Decreased FVC

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4
Q
  1. Question: A patient with sarcoidosis presents for elective surgery. Preoperatively, you note that their arterial blood gas shows a reduced PaO2. What pathophysiological aspect of sarcoidosis could contribute to this finding?
A

diffusion impairment d/t alveolar membrane thickening

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5
Q
  1. Question: Which of the following is a common cause of acute pulmonary edema in the perioperative setting?
A

Increased capillary permeability

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6
Q
  1. Question: A patient with kyphoscoliosis is undergoing surgery. Intraoperatively, you notice an increased requirement for oxygen. What pathophysiological feature of kyphoscoliosis most likely explains this increased oxygen requirement?
A

reduced chest wall compliance l/t hypoventilation

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7
Q
  1. Question: A patient with a history of hypersensitivity pneumonitis is scheduled for surgery. Considering their lung pathology, what is a key consideration for perioperative management?
A

susceptibility to postoperative ventilatory failure

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8
Q
  1. Question: During anesthesia induction for a patient with restrictive lung disease, you observe a marked decrease in tidal volumes. What underlying pathophysiological change is most likely responsible for this observation?
A

decreased lung compliance and reduced chest wall expansion

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9
Q
  1. Question: Following extubation after a thyroidectomy, a patient develops a cough, tachypnea, and oxygen desaturation. What is the most likely diagnosis?
A

Negative pressure pulmonary edema

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10
Q
  1. Question: A 55-year-old patient with a history of idiopathic pulmonary fibrosis is undergoing laparoscopic abdominal surgery. Intraoperatively, the patient exhibits a sudden decrease in oxygen saturation to 88%, with increased peak airway pressures. Blood gases show a PaO2 of 55 mm Hg and PaCO2 of 50 mm Hg. The patient’s preoperative pulmonary function tests indicated a significantly reduced DLCO. Which of the following is the most appropriate immediate management strategy for this patient?
A

decreased tidal volume and increased RR, considering the risk of VILI

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11
Q
  1. Question: A 45-year-old male patient with a history of severe OSA is undergoing anesthesia for elective surgery. The patient has a known history of hypertension. Which of the following best explains the pathophysiological relationship between OSA and hypertension?
A

intermittent hypoxia and hypercarbia from apneic episodes stimulate sympathetic activity l/t increased peripheral vascular resistance

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12
Q
  1. Question: A 55-year-old male with a history of hypertension presents with excessive daytime sleepiness and loud snoring. Polysomnography reveals frequent obstructive apnea events. Which of the following is the primary pathophysiological mechanism contributing to his obstructive apnea?
A

functional upper airway obstruction during sleep

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13
Q
  1. Question: Which of the following cardiovascular consequences is most directly associated with obstructive sleep apnea?
A

HTN d/t increased sympathetic activity

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14
Q
  1. Question: In patients with obstructive sleep apnea, which of the following metabolic derangements is most commonly associated with the condition?
A

insulin resistance and glucose intolerance (d/t inflammation)

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15
Q
  1. Question: A patient with severe OSA is prescribed continuous positive airway pressure (CPAP) therapy. Which of the following best describes the primary mechanism of action of CPAP in treating OSA?
A

increasing pharyngeal transmural pressure to maintain airway patency

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16
Q
  1. Question: In a patient with congestive heart failure (CHF) and Cheyne-Stokes breathing, which pathophysiologic feature is primarily responsible for the periodic breathing pattern observed?
A

heightened chemoreceptor responsiveness to CO2 and O2

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17
Q
  1. Question: What is the primary cause of CSA with Cheyne-Stokes breathing in chronic renal failure (CRF)?
A

acid-base disturbances and compensatory hyperventilation

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18
Q
  1. Question: What is a major pathophysiologic consequence of CSA with Cheyne-Stokes breathing?
A

severe hypoxia and sleep disruption l/t increased cardiovascular strain

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19
Q
  1. Question: In a patient with long-term opioid use presenting with CSA, which of the following best explains the pathophysiological mechanism of their sleep apnea?
A

suppression of respiratory control through mu-opioid receptors in the medullary pre-Botzinger complex

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20
Q
  1. Question: Which of the following is a primary contributor to the pathogenesis of Obesity Hypoventilation Syndrome (OHS)?
A

decreased chemosensitivity to CO2

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21
Q
  1. Question: In adult patients with a history of upper respiratory infection (URI), which factor significantly increases the risk of perioperative respiratory adverse events (PRAE) during anesthesia?
A

Hx of copious secretions and reactive airway disease

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22
Q
  1. Question: In a patient experiencing an acute exacerbation of asthma, what is the most common arterial blood gas finding?
A

hypocarbia and respiratory alkalosis

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23
Q
  1. Question: In an asthmatic patient scheduled for surgery, which pulmonary function test measurement is directly indicative of the severity of expiratory airflow obstruction?
A

FEV1

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24
Q
  1. Question:A 35-year-old patient with a history of severe asthma is scheduled for elective surgery. During preoperative assessment, the patient’s FEV1 is found to be 60% of the predicted value. Which of the following is the most appropriate next step in management?
A

continue current asthma medications and proceed w/ surgery

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25
Q
  1. Question: In a patient with advanced COPD, what pathophysiological change is primarily responsible for the increased risk of air trapping and hyperinflation during anesthesia?
A

decreased lung compliance

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26
Q
  1. Question: During preoperative evaluation for a COPD patient, echocardiography revealed evidence of right ventricular hypertrophy. This finding most likely indicates:
A

pHTN

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27
Q
  1. Question: A 65-year-old patient with severe COPD is scheduled for lower limb surgery. Which of the following anesthesia techniques is most appropriate for this patient?
A

Regional anesthesia

28
Q
  1. Question: Which of the following is a risk associated with the use of an interscalene block in a patient with severe COPD?
A

Interscalene block can cause ipsilateral phrenic nerve palsy and should be avoided in patients with severe COPD

29
Q
  1. Question: Considering the pathophysiology of cystic fibrosis, which factor most significantly impacts the management of airway secretions during anesthesia?
A

increased production of thick mucus d/t abnormal CFTR gene function

30
Q
  1. Question: A 58-year-old patient with a history of severe restrictive lung disease is scheduled for thoracic surgery. Preoperative spirometry shows a Total Lung Capacity (TLC) of 45% of the predicted value. Which of the following is the most likely pathophysiological mechanism underlying this patient’s condition?
A

decreased lung compliance and reduced surface area for gas diffusion

31
Q
  1. Question: A patient with acute intrinsic restrictive lung disease presents with bilateral, symmetric perihilar opacities on chest radiography, suggesting pulmonary edema. What is the most likely pathophysiological process leading to this radiographic finding?
A

increased capillary pressure causing hydrostatic pulmonary edema

32
Q
  1. Question: During a postoperative period, a patient who underwent surgery for obstructive sleep apnea develops tachypnea, cough, and oxygen saturation below 95%. The patient’s recent surgery history most likely predisposes them to which of the following types of pulmonary edema?
A

negative pressure pulmonary edema

33
Q
  1. Question: A patient with a history of connective tissue disease presents with dyspnea and a reduced forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC). Radiography shows a reduction in lung volumes. Which pathophysiological process is most likely responsible for these findings?
A

pulmonary fibrosis l/t reduced lung compliance and decreased lung volumes

34
Q
  1. Question: A 45-year-old patient who recently underwent pneumothorax treatment presents with pulmonary edema. Considering the rapid reexpansion of the collapsed lung, which pathophysiological mechanism is most likely responsible for the pulmonary edema in this patient?
A

enhanced capillary membrane permeability l/t fluid accumulation

35
Q
  1. Question: During an anesthesia assessment after a colonoscopy by another provider, a patient exhibits symptoms of acute chemical pneumonitis following aspiration. What pathophysiological process primarily contributes to the development of this condition?
A

aspiration of gastric contents causing destruction of surfactant producing cells and pulmonary capillary endothelium damage

36
Q
  1. Question: A patient presents with respiratory symptoms following prolonged use of e-cigarettes. The clinical and radiological findings are suggestive of EVALI. What is the primary pathophysiological mechanism behind this condition?
A

inhalation of harmful substances l/t diffuse alveolar damage and acute fibrinous pneumonitis

37
Q
  1. Question: In a patient with acute respiratory failure, arterial blood gas analysis reveals a Pao2 of 55 mm Hg despite oxygen supplementation and a Paco2 of 52 mm Hg. What does this indicate about the patient’s respiratory status?
A

acute respiratory failure w/ respiratory acidosis

38
Q
  1. Question: A 50-year-old male with severe ARDS is undergoing mechanical ventilation. You are considering the ventilation strategy that would minimize ventilator-induced lung injury (VILI) and systemic inflammatory response. Which strategy aligns with this pathophysiological consideration?
A

low tidal volume ventilation (6ml/kg predicted body weight)

39
Q
  1. Question: A critically ill ARDS patient is being managed in the ICU. Considering the pathophysiological implications of fluid balance in ARDS, which aspect is most critical for mortality reduction?
A

conservative fluid management to achieve negative euvolemia

40
Q
  1. Question: A patient with severe ARDS is being considered for prone positioning. From a pathophysiological perspective, what is the primary benefit of this intervention?
A

improved ventilation/perfusion matching through recruitment of dorsal lung regions

41
Q
  1. Question: A 60-year-old patient with a history of interstitial lung disease (ILD) is scheduled for elective surgery. The patient presents with chronic dyspnea and a nonproductive cough. As a Nurse Anesthesiologist, which of the following considerations is most crucial for perioperative management due to the pathophysiological changes associated with ILD?
A

cautious use of fluid management to avoid exacerbating restrictive lung physiology and potential HTN

42
Q
  1. Question: During a preoperative assessment for a patient with sarcoidosis, you note the history of endobronchial involvement. What anesthetic implication should be primarily considered due to this pathophysiological feature?
A

potential difficulty w/ tracheal intubation and the need for smaller ET tubes

43
Q
  1. Question: In a patient with severe restrictive lung disease undergoing a major surgical procedure, which of the following is a key consideration for mechanical ventilation due to the underlying pathophysiology?
A

use of lower tidal volumes to accommodate reduced lung compliance and prevent barotrauma

44
Q
  1. Question: A 45-year-old patient with severe kyphoscoliosis (Cobb angle > 100 degrees) is scheduled for elective surgery. As a Nurse Anesthesiologist, what primary anesthetic challenge should you anticipate due to the pathophysiology of this condition?
A

hypoventilation

45
Q
  1. Question: A patient with a large mediastinal mass is scheduled for biopsy. Which of the following is the most critical pathophysiological concern during anesthesia induction?
A

The method of induction of anesthesia and tracheal intubation in the presence of mediastinal tumors depends on the preoperative assessment of the airway.

46
Q
  1. Question: In a quadriplegic patient with spinal cord injury at C4, which anesthetic challenge is most relevant due to the pathophysiological changes associated with the condition?
A

breathing is maintained solely by the diaphragm

47
Q
  1. Question: A patient with myasthenia gravis is scheduled for elective surgery. Considering the pathophysiology of myasthenia gravis, what is a key consideration for the use of neuromuscular blocking agents during anesthesia?
A

Increase sensitivity to nondepolarizing muscle relaxants and resistance to succinylcholine

48
Q
  1. Question: A 58-year-old male with severe OSA is scheduled for a laparoscopic cholecystectomy. He is using CPAP at home but has significant pulmonary hypertension. What anesthetic management strategy is most appropriate for this patient to mitigate the risk of right heart failure during surgery?
A

use of inhaled pulmonary vasodilators to manage pulmonary artery pressures

49
Q
  1. Question: During complex spine surgery, a patient with untreated OSA experiences significant blood loss leading to hypotension. Given the patient’s history of OSA, what is the most immediate concern related to his pathophysiology?
A

Oxygenation? Avoiding O2 carrying capacity/anemia?

50
Q
  1. Question: A patient with OSA undergoing a thyroidectomy develops stridor post-extubation. Considering the underlying pathophysiology of OSA, what is the most likely cause?
A

laryngeal edema exacerbating pre-existing upper airway obstruction

51
Q
  1. Question: An obese patient with OSA is undergoing elective bariatric surgery. Midway through the procedure, the patient exhibits a sudden decrease in tidal volumes with high peak airway pressures. What pathophysiological condition related to OSA could contribute to this intraoperative issue?
A

atelectasis d/t obesity hypoventilation syndrome and reduced chest wall compliance

52
Q
  1. Question: A 62-year-old female with OSA and chronic hypertension is scheduled for a hysterectomy. She is maintained on a beta-blocker. During the induction of anesthesia, she experiences a hypertensive crisis. What pathophysiological interaction related to OSA could explain this event?
A

Sympathetic rebound hypertension due to beta blocker interference with compensatory mechanisms

53
Q
  1. Question: In a patient with OSA, postoperative respiratory depression occurs after receiving standard doses of morphine for analgesia. Which pathophysiological feature of OSA is most likely to have contributed to this enhanced sensitivity to opioids?
A

decreased opioid metabolism from hypoxia-induced hepatic dysfunction

54
Q
  1. Question: A patient with severe OSA is undergoing a total knee replacement. Despite appropriate dosing, the patient has a delayed emergence from anesthesia. What pathophysiological mechanism unique to OSA could contribute to this delayed recovery?
A

reduced metabolism of anesthetic agents d/t hypoxic liver injury

55
Q
  1. Question: During a facelift procedure on a patient with OSA, the nurse anesthesiologist notes a progressive increase in end-tidal carbon dioxide (ETCO2) despite no changes in minute ventilation. What underlying pathophysiological process in OSA could explain this finding?
A

V/Q mismatch d/t upper airway obstruction

56
Q
  1. Question: A patient with OSA develops postoperative pneumonia. Considering the pathophysiology of OSA, which factor likely contributed to this complication?
A

aspiration d/t impaired upper airway reflexes

57
Q
  1. Question: A patient with OSA is in the ICU following a cardiac bypass surgery. He is experiencing repeated episodes of desaturation despite being on supplemental oxygen. What pathophysiological mechanism related to OSA could be contributing to these episodes?
A

central sleep apnea resulting in periodic breathing and apneic spells. decreased sensitivity to O2 and CO2

58
Q
  1. Question: A 62-year-old patient with chronic obstructive pulmonary disease (COPD) is scheduled for an abdominal surgery. During the procedure, you notice a gradual increase in peak airway pressures and a decrease in tidal volumes. What pathophysiological aspect of COPD is likely contributing to this change?
A

dynamic hyperinflation and air-trapping

59
Q
  1. Question: A patient with asthma is undergoing a minor surgical procedure. Midway, they develop wheezing and bronchospasm. Considering the pathophysiology of asthma, which anesthetic management adjustment is most appropriate?
A

deepening anesthesia w/ VA

60
Q
  1. Question: A patient with a history of bronchiectasis presents for lung resection surgery. What is a key consideration in anesthetic management due to their underlying pathophysiology?
A

may need frequent suctioning

61
Q
  1. Question: A patient with severe asthma requires emergency surgery. Considering their pathophysiology, what is a critical preoperative consideration?
A

conflict between protection of the airway in someone at risk of aspiration and the possibility of triggering significant bronchospasm.

62
Q
  1. Question: During the induction of anesthesia in a patient with acute exacerbation of COPD, you observe a rapid increase in CO2 levels. What pathophysiological feature of COPD is likely causing this observation?
A

V/Q mismatch

63
Q
  1. Question: A patient with bronchiectasis is undergoing a thoracic surgery. Postoperatively, they develop significant atelectasis. What aspect of their disease pathophysiology contributes most to this complication?
A

decreased mucociliary clearance l/t airway blockage

64
Q
  1. Question: A patient with a history of severe asthma is scheduled for elective surgery. They have been on long-term oral corticosteroid therapy. What is a key anesthetic consideration related to their medication history?
A

risk of adrenal insufficiency under stress

65
Q
  1. Question: During a laparoscopic procedure on a patient with COPD, you notice an unexpected decrease in oxygen saturation. What pathophysiological feature of COPD could be contributing to this sudden change?
A

increase in intrapulmonary shunting (v/q mismatching)

66
Q
  1. Question: A patient with asthma experiences a severe bronchospastic episode during anesthesia induction. Which pathophysiological trait of asthma is most directly responsible for this event?
A

increased airway reactivity

67
Q
  1. Question: A patient with COPD shows a significant increase in bronchial secretions during anesthesia. Considering the pathophysiology of COPD, what is the most likely cause of this increase?
A

exacerbation of chronic bronchitis component of COPD

Pathophysiology (10 decks)

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