Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
181 Cards in this Set
- Front
- Back
|
Air containing spaces greater than 1 cm in diameter that result from destruction and dilation of airspaces distal to terminal bronchioles are known as:
a. pulmonary fibrosis b. blebs c. bullae d. sarcoid |
C. Bullae
- is a form of emphysema |
|
|
Collections of air within the pleura that do not involve the acinus and are not a form of emphysema are known as:
a. blebs b. bullae c. sarcoid d. pulmonary fibrosis |
A. Blebs
- interstitial emphysema could be known as "multiple blebs" and is a complication of assisted ventilation or if air from other sites has dissected backward into the lung. |
|
|
Mild COPD is characterized by FEV1/FVC and FEV1
a. <70 %, >80% b.>70%,<80% c,<60% , >80% d.<70%, <30% |
A. mild copd is FEV1/FVC ,70%, adn FEV1>80%
|
|
|
Severe COPD is characterized by FEV/FVC <70% and FEV1 <30%.
|
.
|
|
|
The following characteristics describe which type of chronic obstuctive pulmonary disease.
-onset in midlife, symptoms slowly progressive, long term smoking history, dyspnea during exercise, largely irreversible airflow limitation a. asthma b.tuberculosis c. bronchiectasis d. obliterative bronchiolitis e. COPD |
E. COPD
|
|
|
Onset early in life, symptoms vary day by day, symptotms occur at night or in early morning, allergy, rhinitis, or eczema, family history, and largely reversible airflow limitation.
a.COPD b.bronchiectasis c. tuberculosis d. asthma |
D. Asthma
|
|
|
-Large volumes of purulent sputum, bacterial infection, coarse crackles, clubbing, bronchial dilation, bronchial wall thickening.
a. copd b.emphysema c.bronchiectasis d. obliterative bronchiolitis |
c, Bronchiectasis
|
|
|
Changes in lung function with COPD pathology include:
a. destruction of lung connective tisssue, b injury and inflammation of the broncial tubes and alveoli increase th eresistance to airflow during both inspiration and expiration. c. lung compliance increases with tissue damage d. the more horizontally placed diaphragm is less able to lift the rib cage, contrraction of the diaphragm is ineffective so abdomen moves inward rather than outward with each inspiration e. increased demands for work output placed on respiratory muscles f. Mis- alignment of of the lung and thorax g. inflammation allows noxious agents in the air to reach more deeply located tissues and to gain access to blood vessels |
Alll apply
|
|
|
Normally inspiration ___________ venous return via a ________________in right atrial pressure.
a. increase/decrease b. decrease /increase |
A. increase/ decrease
|
|
|
Patients with COPD normally have a _______in CO.
a. increase b. decrease |
a. increase, due to an increase in catecholamine levels and by a redistribution of blood flow and volume from the high capacitance splanchnic regions to the lower capacitance cardiac, cerebral , and muscle regions.
|
|
|
Patients with hypoxic and hypercapnic respiratory failure ( emphysema, chronic bronchitis) have impaired_renal function with reduced renal plasma flow and a decrease in GFR.
|
.
|
|
|
FEV 1 is typically less than ________ % of FVC in the presence of COPD.
a. 20 b.30 c 60 d.80 |
d. 80
|
|
|
PaO2>60mmHg, PaCO2 normal is characteristic of
a. pink puffers b. blue bloaters |
a. pink puffers
|
|
|
PaO2<60mmHg, PaCO2 > 45mmHg and presence of cor pulmonale is characteristic of
a. pink puffers b. blue bloaters |
b. blue bloaters
|
|
|
True or False- Pink puffers are more likely to have severe emphysema and blue bloaters are more likley to have chronic bronchitis
|
True
|
|
|
Cyanosis occurs if the arterial blood contanes more than ______g of deoxygenated Hb per deciliter of blood.
a. 2 b.3 c. 4 d. 5 |
D. 5g
|
|
|
The appearance of a eprson who is emaciated, pursed lip breathing, anxious , using accessory muscles and has normal to cool extremities would be a
a. pink puffer with predominant emphysema b. blue bloater with predominant bronchitis |
a. pink puffer with predominant emphysema
|
|
|
A person who presents as overweight, dusky, and has warm extremites is likely
a. a pink puffer with predominant emphysema b. a blue bloater with predominant bronchitis |
b. A blue bloater with predominant bronchitis.
|
|
|
A chest x ray showing hyperinflation (flattening of the diaphragm with the loss of the silhouette) and hyperlucency caused by arterial vascular deficiency in the lung periphery is indicative of
a. emphysema b. chronic bronchitis |
a. emphysema
|
|
|
True or False: supplemental O2 is usually indicated preoperatively if the PaO2 is less than 70 mmHg if the hemtocrit is greater than 65% or if there is evidence of cor pulmonale
|
F supplemental O2 is indicated if PaO2 is less than 60mmHg if the hematocrit is greater than 55 or if there is evidence of cor pulmonale.
|
|
|
Statement: Surgery is not likely to be withheld on the basis of a decrease in ventilatory capacity, because PATIENTS WITH fev 1 IN THE low range of 0.3 to 1 L often undergo surgery from anesthesia successfully.
|
.
|
|
|
The appearance of a person who is emaciated, pursed lip breathing, anxious , using accessory muscles and has normal to cool extremities would be a
a. pink puffer with predominant emphysema b. blue bloater with predominant bronchitis |
a. pink puffer with predominant emphysema
|
|
|
A person who presents as overweight, dusky, and has warm extremites is likely
a. a pink puffer with predominant emphysema b. a blue bloater with predominant bronchitis |
b. A blue bloater with predominant bronchitis.
|
|
|
A chest x ray showing hyperinflation (flattening of the diaphragm with the loss of the silhouette) and hyperlucency caused by arterial vascular deficiency in the lung periphery is indicative of
a. emphysema b. chronic bronchitis |
a. emphysema
|
|
|
True or False: supplemental O2 is usually indicated preoperatively if the PaO2 is less than 70 mmHg if the hemtocrit is greater than 65% or if there is evidence of cor pulmonale
|
F supplemental O2 is indicated if PaO2 is less than 60mmHg if the hematocrit is greater than 55 or if there is evidence of cor pulmonale.
|
|
|
Statement: Surgery is not likely to be withheld on the baiss of a decrease in ventilatory capacity, becaUSE PATIENTS WITH fev 1 IN THE low range of 0.3 to 1 L often undergo surgery from anesthesia successfully.
|
.
|
|
|
True or False: A patient with high peak airway pressures greater than 60 mmHG will be able to successfully be placed on the anesthesia ventilator.
|
False: A patient with peak airway pressures of this magnitude will create impedence to the high compressible volume of the anestheisa circuit, preventing adequate ventilation. These patients will need to have the ICU ventilator brought to the OR with them.
|
|
|
The pharynx extends from the upper border of the base of the skull down to ______ vertebral level where it becomes continuous with the esophagus. This is also the level of the cricoid cartilage.
|
C6
|
|
|
Blood supply to the entire mouth and pharyngeal region comes from branches of which major artery?
a.external carotid b. internal carotid c. vertebral arteries d. facial vein |
A.
|
|
|
The larynx coincides with what vertebral level?
a. C1-C2 b. C3-C6 c. C6-T1 d. C3,4,5 |
B. C3-6
|
|
|
In the adult, where is the narrowest portion of the airway in the larynx?
a. vocal cords b. just below the cords (subglottic) c. pharynx d. epiglottis |
A
|
|
|
Kids <10, what portion of the airway is the narrowest?
a. cords b. subglottic c. epiglottic area d. same as adult |
B. Just below the cords at the level of the cricoid cartilage.
|
|
|
What nerve provides sensation to the posterior 1/3 of the tongue down to the dorsal side of the epiglottis?
|
CN IX (glossopharyngeal)
|
|
|
What does the external branch of the superior laryngeal nerve do?
a. motor to the cricothyroid muscle b. sensory to the trachea c. sensory to posterior pharynx d. who cares |
A is correct. This muscle increases the tension on the cords. Injury can cause hoarse, weak, easily fatigued
|
|
|
What does the internal branch of the superior laryngeal nerve do?
a. sensory to the trachea b. controls the intrinsic muscles of the larynx c. sensory for laryngeal side of epiglottis down to the cords |
C.
|
|
|
T/F: The RLN supplies sensation to the larynx below the cords and innervates all muscles of the larynx EXCEPT the cricothyroid and interarytenoids.
|
TRUE
|
|
|
The carina is located at what vertebral level?
|
T4-5 which is at the level of the 2nd rib and also the Angle of Louis/sternal angle.
|
|
|
Airway terms as they progress.....
main stem bronchi--> lobar bronchi--> segmental bronchi--> bronchioles--> terminal bronchials (1mm diameter)-->respiratory bronchials-->alveolar ducts-->atria-->alveoli |
.
|
|
|
At what level of the airway or what division is the first place where gas exchange with blood occurs?
a. respiratory bronchials b. alveoli c. bronchus d. atria |
A. nag pg 564
|
|
|
Another name for the conducting zone of the resp tract (nose to terminal bronchioles)
a. dead space b. respiratory zone c. gas exchange area d. Gyton |
A
|
|
|
The phrenic nerve arises from which spinal nerve roots?
a. C 1,2,3 b. C3,4,5 c. dorsal horn d. CN XII |
B
|
|
|
Why do we give NaHco3 to arrest pts?
|
it restores protein-receptor sensitivity and enzymatic functions so epi can be effective
|
|
|
A change if 10 mmHg PaCo2 produces what change in pH?
|
0.08
|
|
|
A base cahnge of 10 meq produces what change in pH?
|
0.15
|
|
|
Which nerves innervate the muscles of resp?
|
C3, 4, 5
|
|
|
The Hering-Breuer inflation reflex prevetns what?
|
overinflation of alveoli
|
|
|
Which nerve provides sensory info for all of airways irritant reflexes?
|
Vagus
|
|
|
What are the two most important chemical factors in control of breathing?
|
arterial and CSF pH
|
|
|
The Hering-Breuer deflation reflex causes what?
|
hypernea if you have a slow resp rate
|
|
|
Three causes of decrease FEV1:
|
1. decrease in bronchial luminal size
2. increase in collapsability of bronchial walls 3. decrease in elastic recoil |
|
|
Narcotics and anesthetic drugs do what tot he CO2 response curve?
|
shift it to the right
(depress ventilatory response to CO2 stimulus) |
|
|
Which chemorecptors play a bigger role in regulating medullary resp centers?
A. Carotid B. Aortic |
A carotid
|
|
|
Which are more important in short term control of CO2: peripheral chemoreceptors or central chemoreceptors?
|
peripheral
|
|
|
Which chemoreceptors are most important in long term control of CO2 levels: peripheral or central?
|
central
|
|
|
What is the pressure in the space between the inside of the chest wall and the lungs?
a. intrapulmonary pressure b. intrapleural pressure |
b
|
|
|
Is always negative during normal tidal breathing.
a. intrapulmonary pressure b. intrapleural pressure |
b
|
|
|
_______ becomes more negative during inspiration and less negative during expiration
a. intrapulmonary pressure b. intrapleural pressure |
b
|
|
|
_________ is negative during inspiration and positive during expiration
a. intrapulmonary pressure b. intrapleural pressure |
a
|
|
|
During normal tidal breathing, when is intrapleural pressure positive?
a. during inspiration b. during expiration c. during inspiration and expiration d. Never |
d
|
|
|
Intrapleural pressure becomes positive during: (choose 2)
a. Forced inspiration b. forced expiration c. valsalva maneuver d. Expiratory pause |
b, c
|
|
|
What 2 muscles contract during normal breathing (eupnea)
a. diaphragm b. internal intercostals c. external intercostals d. accessory muscles |
a, c
|
|
|
During inspiration, the ________contracts and pulls the lower surface of the lungs downward increasing the superior-inferior dimension of the chest.
a. external intercostal muscles b. diaphragm c. abdominal recti d. internal intercostals |
b
|
|
|
During inspiration, _________ increases the anterior-posterior diameter by elevating the ribs and sternum
a. external intercostal mus. b. diaphragm c. abdominal recti d. internal intercostals |
a
|
|
|
What nerve is diaphragm innervated by:
|
phrenic
|
|
|
results from passive recoil of the chest wall and does not require muscular contraction.
|
eupneic expiration
|
|
|
During forced expiration, what muscles are used.
a. rectus abdominis b. transversus abdominis c. external obliques d. internal obliques |
they all are used
|
|
|
What two additional muscles are used during forceful inspiration in conjunction with the diaphragm and intercostals.
|
sternocleidomastoid and scalene muscles
|
|
|
How many cm (avg) does the diaphragm descend during eupneic breathing.
a. 2-3 cm b. 1-2 cm c. 4-5 cm |
b
|
|
|
defined as the change in volume divided by the change in pressure.
a. lung compliance b. static compliance c. dynamic compliance d. plateau pressure |
a
|
|
|
is the pressure-volume relationship for a lung when the air is not moving.
a. dynamic compliance b. static compliance |
b
|
|
|
conditions such as fibrosis, obesity, vascular engorgement, edema, ARDS cause a decrease in
a. dynamic compliance b. static compliance |
b.
|
|
|
What condition will cause static compliance to Increase?
|
emphysema
|
|
|
Much of the energy required to expand the lungs, particularly at low volumes, is created by?
a. elastic recoil b. surface tension c. plateau pressure |
b
|
|
|
Is the pressure observed if you retard exhalation momentarily when the lungs are at end-inspiration
|
plateau pressure
|
|
|
Is the compliance of the lung while the air is moving?
|
dynamic compliance
|
|
|
What is responsible for emptying the lung during exhalation.
a. elastic recoil b.intrapulmonary pressure c. lung compliance |
a
|
|
|
pulmonary surfactant is created by?
|
alveolar type II cells
|
|
|
What reduces surface tension of the lungs and prevents alveolar collapse
|
surfactant
|
|
|
The difference between intraalveolar pressure and pleural pressure is called.
|
transpulmonary pressure
|
|
|
________ flow occurs in smaller airways, where the diameter is small and linear velocity is very low.
a. laminar flow b. turbulent flow |
a
|
|
|
_______ flow is caused by sudden branching of the airways and produces the breath sounds heard on auscultation
a. laminar flow b. turbulent flow |
turbulent flow
|
|
|
Under normal circumstances, the greatest resistance to airflow resides in?
a. alveoli b. terminal bronchial's c. med-sized bronchi |
c
|
|
|
The amount or O2 consumed by the ventilatory muscles during eupneic breathing is usually less than _________% of the total body O2 uptake
a. 2 % b. 10% c. 5% |
c
|
|
|
_________ can cause gas trapping, which in turn can result in a barrel chest and increased lung volumes.
a. airway restriction b. airway obstruction |
b
|
|
|
________ is that phase of expiration that occurs as nitrogen-rich alveoli at the lung apexes continue to empty after closure of the small airways in the base of the lungs.
|
closing volume
|
|
|
Is it possible for closing volume to exceed FRC in the elderly population
|
Yes
|
|
|
What can happen when closing volume exceeds FRC?
a. pneumothorax b. intrapulmonary shunt c. hypoxia |
b
|
|
|
The volume of the conducting airways is called?
a. anatomical deadspace b. Physiological deadspace |
a
|
|
|
anatomic dead space normally equals.
a. 1ml/kg b. 2ml/kg c. 3ml/kg |
b
|
|
|
What is the calculation for physiologic dead space?
|
Vds = (Paco2 -PEco2)/Paco2
|
|
|
T or F
alveoli at the bottom of the lung increase their volume more with each inspiraiton and decrease their volume more with each expiration during eupnea than do those alveoli at the top |
True
|
|
|
What is the average volume of gas removed during exhalation?
How much of this volume consist of Co2 |
350ml
5-6% |
|
|
Every minute, approx. 250ml of O2 diffuses from the alveoli into the pulmonary capillary blood, whereas approx. 200ml of CO2 diffuse from the pulmonary capillary blood into the alveoli. (ratio)
What is this called? |
respiratory quotient
normal 0.8 (200/250) |
|
|
What happens to PACO2 and PaCO2 if alveolar ventilation is doubled?
|
PACO2 is inversely proportional to alveolar ventilation.....they would be reduced by half!
|
|
|
What 2 things supply blood to the lungs.
a. bronchial arteries b. SVC c. pulmonary arteries d. Pelvic artery |
a, c
|
|
|
Pulmonary circulation provides blood flow to the structures (distal or proximal) to the terminal bronchioles
|
distal.....including distal non-respiratory tissues, and respiratory units.
|
|
|
What are the diagnostic tests for suspected PE
|
-O2 saturation
-d-Dimer -Electrocardiogram -Lung scanning -Chest CT -Pulmonary angiogram -Echocardiography -Venous ultrasonography -MRI |
|
|
Conditions associated with increased risk for Deep Vein Thrombosis includes all the following EXCEPT:
a. Advancing age 2. Obesity 3. Previous venous thromboembolism 4. Surgery 5. Cancer in remission 6. Trauma |
5. Cancer in remission (Active cancer is associated with DVT)
|
|
|
what is the aim of anesthesia management for patients at risk for PE?
|
-To support vital-organ function and minimize anesthetic-induced myocardial depression.
|
|
|
What is the use of high FiO2 in PE patients?
|
-To aid the prevention of pulmonary vasoconstriction.
|
|
|
The reason why many anesthesia providers choose not to place pulmonary artery catheters in patients at risk for PE is due to:
|
-concerns about the possibility that the catheters may dislodge clots in the right side of the heart.
|
|
|
What is the drug of choice for anesthetic induction in patients at risk for PE? and why?
|
-Etomidate or Ketamine
-For maintenance of hemodynamic stability; but ketamine must be titrated judiciously because it may increase PVR. |
|
|
What signs can aid in detection of PE during anesthesia?
|
-Decrease PETCo2
-Tachycardia -Decrease SaO2 -Unexplained arterial hypoxemia -Increased PAP and CVP -Decrease systolic and diastolic BP -ECG changes that indicate right axis deviation -Incomplete or complete right BBB -Peaked T waves -Systolic ejection murmur |
|
|
What are the first symptoms that aid in detection of PE during anesthesia?
|
-Decreasing PETCO2
-Tachycardia |
|
|
True or False: Intraoperative management of a PE patient during anesthesia includes:
a. airway b. discontinuation of anesthetic agent c. circulatory support with IV fluids and blood. d. IV epinephrine for dysrhythmias. e. PEEP (for optimization of O2 transport across the alveolar membrane). |
A,B,C,E
-D is false-(IV Lidocaine is used in treatment of dysrthymias). |
|
|
Define obstructive pulmonary disease
|
Any condition that interferes with normal lung expansion during inspiration.
|
|
|
In Restrictive pulmonary disease; FEV1 and FVC are both (decreased/increased)
|
Decreased (due to a reduction in TLC or a decrease in chestwall compliance or muscle strength.
|
|
|
True or False:
In Restrictive pulmonary disease, FEV1/FVC ratio is low. |
False (FEV1/FVC ratio is either normal or elevated.
|
|
|
Impairment-producing restrictive pulmonary diseases can be classified into these 3 disorders:
a. Acute intrinsic disorders b. Chronic intrinsic diseases c. Acute extrinsic diseases d. Chronic extrinsic diseases |
a, b, d.
|
|
|
True or False:
Pulmonary edema is an independent disease entity. |
False (Pulmonary edema is NOT itself an independent disease entity, but the result of a variety of disease processes.
|
|
|
Define Pulmonary edema.
|
-Accumulation of excess fluid in the interstitial and air-filled spaces of the lung.
|
|
|
Name the four Starling forces
|
The four Starling’s forces are:
-Hydrostatic pressure in the capillary (Pc) -Hydrostatic pressure in the interstitium (Pi) -Oncotic pressure in the capillary (pc ) -Oncotic pressure in the interstitium (pi ) The balance of these forces allows calculation of the net driving pressure for filtration. Net Driving Pressure = [ ( Pc - Pi ) - ( pc - pi ) ] |
|
|
T or F COPD pt are at increased risk of needing postop ventilator support if prop sx include low PaO2 and dypnea at rest.
|
True
|
|
|
Regional anesthesia for a COPD pt should not be above _____.
|
T6 due to risk of decreasing expiratory reserve volume, impairing cough effort, and anxiety provoked weakness.
|
|
|
Volatile agents may have what adverse effect on the COPD pt resipratory tract?
|
Reduce funtion of cilia
|
|
|
GA is associated with an/a increase/decrease of alceolar-arterial difference in PO2.
|
Increase
|
|
|
What is the percent decrease in FRC with NMBer's
|
20%
|
|
|
Pt with hyperinflated lungs have less cfhance of developing atelectasis.
|
statment
|
|
|
What manuever can the CRNA do with the ventilator to help improve oxygentation during surgery for chronic lung pt?
|
Sigh
|
|
|
COPD pt requires a higher TV. True of false
|
True. Improves gas exchange at the periphery of the lobule.
|
|
|
How can the CRNA detect auto peep in the COPD pt?
|
By assessing whethe exhalation is still taking place when the next exhalation starts.( auto peep also called intrinsic PEEP or PEPi)
|
|
|
If PEEP is added for these pt in what increments should it be titrated?
|
2.5-5 cm H2O
|
|
|
I:E ratio shoud be adjusted so
that __________ is prolonged so that decrease in PEEPi is facillitated. |
expiration
|
|
|
Name 3 things that characterize post op pulmonary complications in COPD pt
|
Atelectasis
pneumonia decrease in PaO2 |
|
|
A permanent change in the airway of an sthmatic is called______.
|
Airway remodeling
|
|
|
Non asthmatic children with a URI are _____ to ____ times more likely to experience an adverse event perioperatively and are more prone to desaturation post operatively.
|
2 to 7
|
|
|
Asprin induced asthma is clinically associated with_____ _____.
|
Nasal polyps
|
|
|
Typicaly asthma pt perserve CO2 elimination until V/Q abnormalities are severe, when it does rise repiratiory failure may be impending.
|
statement
|
|
|
Treatment Options for patients with Pulmonary HTN:
A. Anticoagulants B. Vasoconstrictors C. Vasodilators D. Inhibitors of Vasoconstriction |
A. Anticoagulants - Prevent PE, vasodilators also needed
C. Vasodilators - Calcium antagonists, Epoprostenol, Nitric Oxide, Alprostadil, Bosentan, Treprostinil, Ambrisentan, Sildenafil, Iloprost D. Inhibitors of Vasoconstriction - Alpha-Adrenoceptor antagonists, ACE inhibitors pg. 595 |
|
|
Classification of Pulmonary HTN:
1. Pulmonary arterial Hypertension (PAH) 2. Pulmonary Hypertension with Left Heart Disease 3. Pulmonary Venous Hypertension (PVH) 4. Pulmonary Hypertension with Lung Disease/Hypoxemia 5. Pulmonary Hypertension Due to Chronic Thrombotic and/or Embolic Disease |
1. Pulmonary arterial Hypertension (PAH)
2. Pulmonary Hypertension with Left Heart Disease 4. Pulmonary Hypertension with Lung Disease/Hypoxemia 5. Pulmonary Hypertension Due to Chronic Thrombotic and/or Embolic Disease pg. 596 |
|
|
Treatment Options for patients with Pulmonary HTN:
A. Anticoagulants B. Vasoconstrictors C. Vasodilators D. Inhibitors of Vasoconstriction |
A. Anticoagulants - Prevent PE, vasodilators also needed
C. Vasodilators - Calcium antagonists, Epoprostenol, Nitric Oxide, Alprostadil, Bosentan, Treprostinil, Ambrisentan, Sildenafil, Iloprost D. Inhibitors of Vasoconstriction - Alpha-Adrenoceptor antagonists, ACE inhibitors pg. 595 |
|
|
Classification of Pulmonary HTN:
1. Pulmonary arterial Hypertension (PAH) 2. Pulmonary Hypertension with Left Heart Disease 3. Pulmonary Venous Hypertension (PVH) 4. Pulmonary Hypertension with Lung Disease/Hypoxemia 5. Pulmonary Hypertension Due to Chronic Thrombotic and/or Embolic Disease |
1. Pulmonary arterial Hypertension (PAH)
2. Pulmonary Hypertension with Left Heart Disease 4. Pulmonary Hypertension with Lung Disease/Hypoxemia 5. Pulmonary Hypertension Due to Chronic Thrombotic and/or Embolic Disease pg. 596 |
|
|
Leading cause of chronic cor pulmonale?
|
COPD is associated with the functional loss of pulmonary capillaries and subsequent arterial hypoxemia; these events initiate pulmonary vasoconstriction, which is the leading cause of chronic cor pulmonale
pg. 596 |
|
|
Diseases associated with hypoxic pulmonary vasoconstriction include:
A. COPD B. Bronchiectasis C. Chronic Mountain sickness D. Valley Fever E. Cystic fibrosis F. Idiopathic alveolar hypoventilation G. Obesity-related hypoventilation syndrome |
A. COPD
B. Bronchiectasis C. Chronic Mountain sickness E. Cystic fibrosis F. Idiopathic alveolar hypoventilation G. Obesity-related hypoventilation syndrome pg. 596 |
|
|
Diseases associated with hypoxic pulmonary vasoconstriction include:
A. Neuromuscular diseas B. Kyphoscoliosis C. Pleuropulmonary fibrosis D. Pneumothorax E. Upper Airway obstruction |
A. Neuromuscular diseas
B. Kyphoscoliosis C. Pleuropulmonary fibrosis E. Upper Airway obstruction pg. 596 |
|
|
Diseases that produce obstruction or obliteration of the pulmonary vasculature include:
A. PE B. Pulmonary fibrosis C. Pulmonary lymphangitic carcinomatosis D. Idiopathic PAH E. Progressive systemic sclerosis F. Croup |
A. PE
B. Pulmonary fibrosis C. Pulmonary lymphangitic carcinomatosis D. Idiopathic PAH E. Progressive systemic sclerosis pg. 596 |
|
|
Diseases that produce obstruction or obliteration of the pulmonary vasculature include:
A. Sarcoidosis B. Intravenous Drug abuse C. Pulmonary vasculitis D. Fatness E. Pulmonary venoocclusive disease |
A. Sarcoidosis
B. Intravenous Drug abuse C. Pulmonary vasculitis E. Pulmonary venoocclusive disease |
|
|
In COPD, the major factors involved in the hemodynamic changes?
|
In COPD, derangements in the intrapulmonary gas exchange are the major factors involved in the hemodynamic changes. Namely, alveolar hypoxia appears to locally mediate the vasoconstriction of precapillary pulmonary vessels.
|
|
|
What potentiates the effects of locally mediated vasoconstriction of precapillary pulmonary vessels.
|
Acidosis and hypercarbia potentiate this effect.
|
|
|
Right ventricular hypertrophy characteristics caused by COPD and PAH?
|
increased firmness of the myocardium and increased thickness of its wall, most prominently in the pulmonary outflow tract.
|
|
|
Occasional hoarsenss in cor pulmonale is caused by?
|
secondary to left recurrent laryngeal nerve compression by the enlarged pulmonary artery in present.
|
|
|
Regional anesthesia technique may be appropriate as long as.....
|
as long as a high sensory level of anesthesia is not required, because any decrease in SVR in the presence of a fixed PVR may produce undesirable degrees of hypotension.
|
|
|
Any decrease in ___ in the presence of a fixed ___ may produce undesirable degrees of hypotension.
|
Any decrease in SVR in the presence of a fixed PVR d/t cor pulmonale may produce undesirable degrees of hypotension.
|
|
|
Volatile agents _______ PVR.
|
Volatile agents decrease PVR
|
|
|
N2O ________ PVR in patients with PPH.
|
N2O increase PVR in patients with PPH.
|
|
|
PAP is __________ by isoflurane.
|
PAP is decreased by isoflurane.
|
|
|
IV agents with the exception of _________ , appear to have ______ effect on PVR
|
V agents with the exception of Ketamine, appear to have little effect on PVR
|
|
|
5 key principles for anesthetic management of cor pulmonale:
>Keep the patient well _________ >Avoid _______ >Avoid the use of exogenous and endogenous ___________ >Avoid presenting stimuli that increase ___________ tone >Avoid _______ |
>Keep the patient well oxygenated
>Avoid acidosis >Avoid the use of exogenous and endogenous vasoconstrictors >Avoid presenting stimuli that increase sympathetic tone >Avoid Hypothermia |
|
|
Most emboli (___) arise in the proximal deep veins of the _____ _________, with the remainder origination from ______ veins.
|
Most emboli (90%) arise in the proximal deep veins of the lower extremities, with the remainder origination from pelvic veins.
|
|
|
Three major factors promote the formation of venous thrombi:
>______ of blood flow >venous _____ >____________ states |
>stasis of blood flow
>venous injury >hypercoagulation states |
|
|
Less common causes of PE include:
A. air B. Tumor C. Bone D. Fat E. Catheter fragments F. Amniotic fluid |
All are correct
|
|
|
Occlusion of approximately __% of the pulmonary vascular bed results in ___ with subsequent _____ ventricular failure, _______ end-diastolic pressures, and development of _________ and possibly _________valved incompetence
|
Occlusion of approximately 70% of the pulmonary vascular bed results in PAH with subsequent right ventricular failure, increased end-diastolic pressures, and development of arrhythmias and possibly tricuspid valved incompetence.
|
|
|
Only common complaint of PE
|
dyspnea of sudden onset
|
|
|
An initial difference between PACO2 and PETCO2 is common early during a __
|
An initial difference between PACO2 and PETCO2 is common early during a PE
|
|
|
Diagnostics for PE
|
Oxygen saturation
D-Dimer - "rule out" if normal EKG - my provide alternative dx Lung scanning - not definative Chest CT - most accurate, gold standard Pulm angio - invasive, costly, uncomfortable, previous gold standard Echo - best as prognostic, large PEs can have normal Venous US - neg does not rule out PE MRI - reliable only for large, proximal pulmonary arteries |
|
|
The normal respiratory quotient (RQ) is what?
|
0.8
RQ= 200ml CO2 procuded divided by 250ml O2 consumed = 0.8 |
|
|
Every minute approximately how much O2 (mls) diffuses from the alveoli in to the pulmonary capillary blood?
|
250 mL
|
|
|
Every minute approximately how much CO2 (mLs) difuses from the pulmonary capillary blood into the alveoli?
|
200 mL
|
|
|
Blood flow to the lungs are provided by what?
|
bronchial arteries (1 on R and 2 on L)
pulmonary arteries (brings unoxygenated blood from the RV) |
|
|
Pulmonary vessels are shorter than systemic vessels with decreased resistance is explained by ___________Law?
|
Poiseuille's Law - a decrease in length decreases resistance PVR 1/8 < SVR
|
|
|
Pulmonary blood flow is more commonly regulated locally by changes in?
|
oxygen and carbon dioxide tension
|
|
|
Local control in regulation of pulmonary blood flow to hypoxic or atelectatic alveoli is actively diverted at the precapillary site is called?
|
hypoxic pulmonary vasoconstriction - decreased blood flow from diseased areas improves V/Q
|
|
|
Matching
1. Zone 1 2. Zone 2 3. Zone 3 a. represents continuous blood flow, dependent portion b. alveolar dead space, ventilated but not perfused. c. variable relationship between vasculare and alveolar pressure |
1. b
2. c 3. a |
|
|
The normal distance for diffusion from the alveolar air space into the pulmonary capillary blood cells is < _____
a. 2 microns b. 1 micron c. 2 cm d. 1 cm |
b. <1 micron
|
|
|
"Leakiness" of the respiratory membrane predisposes it to unintended movement of fluid causing?
|
pulmonary edema
|
|
|
Pulmonary edema affects ______ more than _______?
a. oxygenation b. CO2 excretion |
Pulmonary edema affects oxygenation more thant CO2 excretion, CO2 is 20 times more diffusible than O2
|
|
|
The drastic decrease in intrathoracic pressures pulls fluid from the pulmonary capillaries during emergence is called?
|
Postobstructive pulmonary edema or negative pressure pulmonary edema
|
|
|
Alveoli that are ventilated but poorly perfused are described as ___________?
a. deadspace like b. shunt like |
a. deadspace like
|
|
|
Alveoli that are perfused but poorly ventilated are referred to as?
a. deadspace like b. shunt like |
b. shunt like - this contributes to the V/Q mismatch of the lungs
|
|
|
Shuntlike alveoli have relatively ____PO2 and ____PCO2
a. high b. low |
low PO2
high PCO2 |
|
|
PEEP causes expansion of zone _____?
|
Zone 1
|
|
|
What is the most common cause of the 10% shunt observed in patients under anesthesia?
|
Atelectasis
|
|
|
Interaction between O2 and Hg is influenced by?
|
pH, PcO2, temp, 2, 3 DPG
|
|
|
The shape of the Oxyhemoglobin dissociation curve is what shape?
|
S-shaped - steep at lower PO2 and nearly flat when PO2 is >70mmHg
|
|
|
A shift to the R of the oxyhemoglobin curve represents?
|
O2 is given up to the tissue - increased tissue metabolism, which increases the tissues' O2 demand
|
|
|
The influence of pH and PcO2 on the HbO2 curve is referred as the ___________?
|
Bohr effect
|
|
|
_______ equation estimates the fraction of cardiac output that perfuses alveoli that are absolutely nonventilated.
|
Shunt equation
|
|
|
100% shunts represents?
|
No oxygenation of arterial blood in the alveolar capillaries
|
|
|
Give a clinical example of a characteristic of a significant shunt?
|
hypoxemia unresponsive to supplemental oxygen administration
|
|
|
80 - 90% of CO2 is carried in the blood as?
|
bicarbonate
|
|
|
When the blood contains mostly deoxyhemoglobin, the CO2 dissociation curve shifts to the left, increasing the capacity to carry CO2, this is called?
|
The Haldane effect- this allows the blood to load more CO2 at the tissues and to unload CO2 at the lung
|
