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103 Cards in this Set
- Front
- Back
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list the 4 lung volumes, their definition, and average adult values (ml).
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1. tidal volume (TV)= each
normal breath = 500ml 2. inspiratory reserve volume (IRV) = max addtl volume insired above TV = 3,000ml 3. expiratory reserve volume (ERV)= max addtl volume expired below TV = 1,100ml 4. residual volume (RV)= volume remaining after max exhalation = 1,200ml |
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list the 2 lung capacities, their definition, and average adult values (ml).
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1. total lung capacity (TLC)
= TV+IRV+ERV+RV = 5,800ml 2. functional residual capacity (FRC) = ERV+RV = 2,300ml |
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what does COPD stand for?
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chronic obstructive pulmonary disease
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what are the 3 pathologic conditions associated w/ COPD?
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1.chronic bronchitis
2.emphysema 3.mucous plugging |
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name 3 airway specific characteristics associated with chronic bronchitis.
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1.obstruction of small
airways 2.hypersecretion of mucus 3.bronchi inflammation |
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name 4 airway specific characteristics associated with emphysema.
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1.destruction of lung
parenchyma; loss of lung elasticity/recoil 2.obstruction of expiratory flow; increased airway resistance 3.collapse of small airways during exhalation 4.enlargement of air spaces from air trapping (bullae) which compress adjacent lung tissue |
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what's the most common cause of resp failure?
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COPD
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is COPD a reversible or irreversible obtructive lung disease?
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irreversible
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what's the #1 cause of COPD?
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cigarette smoking > 10 yrs
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what's diagnostic criteria for chronic bronchitis?
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productive cough due to hyersecretion of mucus > 3 months during > 2 successive yrs
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what's prognosis of chronic bronchitis pt's after having 1st episode of acute resp failure?
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death w/in 5 yrs
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what are "blue bloaters"?
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pt's suffering from chronic bronchitis due to marked decreases in PaO2
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name 5 problems associated w/ right ventricular hypertrophy due to chronic bronchitis.
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1.systemic HTN
2.JVD 3.peripheral edema 4.passive hepatic congestion 5.occasionally ascites |
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name a problem associated w/ left ventricular hypertrophy due to chronic bronchitis.
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pleural effusion
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what are 3 typical physical features of "blue bloaters"?
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1.overweight
2.dusky, warm extremities 3.40-55 yo |
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name 4 causes (other than smoking) for bronchitis.
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1.air pollution
2.infection 3.familial factors (genetics) 4.allergies |
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what makes acute bronchitis different from chronic bronchitis?
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acute bronchitis is self limiting
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what is the typical cause of acute bronchitis?
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viral infection w/ upper resp tract illness
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in chronic bronchitis what happens to pts:
a.breathing pattern b.PaO2 c.PaCO2 d.pulmonary vasculature e.blood hematolgy f.cardiac system |
a.breathing pattern = moderate dyspnea
b.PaO2 = marked decrease < 65mmhg ("blue bloater") c.PaCO2 = increased d.pulmonary vasculature = marked cor pulmonale (from arterial hypoxemia & resp acidosis) e.blood hematolgy = increaed HCT (from chronic arterial hypoxemia) f.cardiac system = right ventricular hypertrophy & left ventricular failure |
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in emphysema what happens to pts:
a.breathing pattern b.PaO2 c.PaCO2 d.pulmonary vasculature e.blood hematolgy |
a.breathing pattern = severe dyspnea
b.PaO2 = modest decrease ("pink puffer" c.PaCO2 = normal to decreased d.pulmonary vasculature = mild cor pulmonale e.blood hematolgy = normal HCT |
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what's the prognosis for pulmonary emphysema?
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good prognosis as long as supplemental oxygen is continued
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what's are 5 PHYSICAL finds of "pink puffers"?
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1.thin, emaciated
2.pursed lip breathing 3.anxious 4.prominent use of accessory muscles 5.normal to cool extremities |
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what diagnostic test best evaluates the progressive nature of airflow obstruction in COPD?
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forced expiratory volume in 1 second (FEV1)
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what happens to FEV1 in COPD?
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decreases significantly (< 40% normal)
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what are the 3 causes of decreased FEV1 in COPD?
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1.decreased size of
bronchial lumina 2.increased collapsibility of bronchial walls 3.decreased elastic recoil of lungs |
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What HABIT can decrease FEV1? and at what age range?
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smoking (esp > 60 yo)
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as COPD advances to severe what happens to breathing patterns? why?
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orthopnea
increased airway secretions + airflow obstruction |
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what is asthmatic bronchitis?
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combo b/t chronic bronchitis & reversible bronchospasms
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in regard to physical examination findings associated w/ COPD, what happens w/:
a.airflow b.HR c.expiratory phase d.breath sounds e.wheezing? |
a.airflow = expiratory
decreased b.HR = increased c.expiratory phase = increased d.breath sounds = decreased e.wheezing? = yes; expiratory wheezing in supine position |
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what's the normal FEV1/forced vital capacity ratio?
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> 80% in healthy pts
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in COPD, what happens w/:
a.FEV1/FVC ratio b.RV c.FRC d.TLC |
a.FEV1/FVC ratio = decreased
b.RV = increased (from air trapping) c.FRC = normal to increased d.TLC = normal to increased |
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what's the advantage of increased RV & FRC?
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enlarged airway diameter and increased elastic recoil
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what does cxr show w/ COPD? (4 things)
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Emphysema findings:
1.hyperlucency of lungs a.arterial vascular deficiency in lung periphery b.hyperinflation 2.flattened diaphragm 3.vertically oriented cardiac silhouette 4.bullae/blebs (air containing spaces) Note: chronic bronchitis rarely shows up on cxr |
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what alterative diagnositic tools can be used to diagnose
emphysema? |
CT
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name the 2 most effective tx for COPD.
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cessation of smoking
chronic administration of O2 |
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when is chronic O2 tx recommended? (3 things)
1.PaO2? 2.Hct? 3.Pulm? |
1.PaO2 < 55 mmHg
2.Hct > 55% 3.evidence of cor pulmonale |
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whats the PaO2 goal of supplemental O2?
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PaO2 60-80 mmHg
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name other drug therapies for COPD. (6 things)
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1.bronchodilators
2.long-acting beta2 agonists 3.corticosteriods 4.intermittent broad antibiotics 5.annual influenza & pneumococcus vaccinations* 6.diuretics* |
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what other benefit besides release of bronchoconstriction does long-acting beta2 agonist provide?
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decreased adhesion of bacteria (i.e. Haemophilus influenza) to airway epithelial cells
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why should you take care in administering diuretics for treating cor pulmonale & right ventricle failure in COPD?
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diuretic-induced chloride depletion results in hypochloremic metabolic alkalosis that
a.depresses the ventilatory drive b.aggravates chronic CO2 retention |
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what is the best method of ventilation for exacerbations of COPD?
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noninvasive positive pressure nasal mask ventalation
avoiding tracheal intubation |
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what is lung volume reduction surgery and it's benefit?
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removal of overdistended, emphysematous regions
allows normal areas to expand increasing FEV1 & potentially PaO2 |
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in the anesth mgmt for lung volume reduction surgery, what type of airway would you use and what 2 things would you want to avoid? (3 things)
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1.double-lumen endobronchial tube
2.avoid N2O (could diffuse into emphysematous bullae) 3.avoid excessive (+) airway pressure a. inspiratory press <20 b. no PEEP |
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give 2 reasons why CVP monitoring is not reliable w/ COPD pts.
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1.gas trapping
2.pulmonary tamponade effect from large emphysematous bullae |
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describe preop treatment of symptomatic COPD. (3)
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1.inhaled ipratropium & beta-
agonists (these 2 have additive effects) 2.2 wk preop systemic corticosteriods 3.preop antibiotics for infections |
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name some preop regimens for decreasing postop complications in COPD pts. (5)
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1.bronchodilators
2.antibiotics 3.smoking cessation (at least 8 wks) 4.corticosteriods 5.physical therapy (educate pt on lung volume expansion techniques) |
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what's the 2 most important SURGICAL PROCEDURE predictor of postop pulmonary complications?
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1.operative site
2.surgery > 3 hrs |
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what operative site has greatest risk for postop pulmon problems?
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abdominal and thoracic
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what effect does anesthetic drugs, NMBAs, and surgical trauma have on lung volumes? (3 things)
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1.decreased FRC
2.decreased VC 3.atelectasis (lasting several days postop) |
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what's the most accurate assessment of postop pulmonary complications in COPD pts?
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H&P (better than PFT & ABGs)
a. Hx: exercise tolerace, chronic cough, unexplained dyspnea b. Physical: decreased breath sounds, wheezing, prlonged expiratory phase |
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what's the benefit of PFTs?
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management not assessing risk
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name 4 intraoperative strategies for decreasing postop pulmonary conmplications in COPD pts.
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1.minimally invasive surgery
(laparoscopy) 2.regional anesthesia 3.avoid long acting NMBA 4.avoid surgical procedures > 3 hrs |
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name 3 postop strategies for decreasing postop pulmonary comlications in COPD pts.
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1.lung volume expansion
maneuvers (IS, deep breathing, chest physical therapy, positive pressure breathing techniques) 2.maximize analgesia 3.improve FRC |
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what surgeries do neuraxial opioids work the best for if you're concerned about resp function postop?
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intrathoracic, upper abdominal, and major vascular surgeries
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name 4 postop benefits of neuraxial opioids.
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1.permit tracheal extubation
2.early ambulation 3.increased FRC & PaO2 (by improving V/Q) 4.restores FEV1 to preop level |
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what causes delayed depression of ventilation w/ neuraxial opioid administration?
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opioids absored into subarachnoid space diffusing into 4th cerebral ventral area depressing medullary ventilatory center
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who is more susceptible to delayed depression of ventilation w/ neuraxial opioids? (4)
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1.elderly
2.sensitivity to opioids 3.co-adm w/ systemic opioids 4.poorly lipid soluble opioids (morphine) |
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name 2 criteria for maintaining mechanical ventilation postop in COPD pts.
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1.FEV1/FVC ratio < 0.5
2.PaCO2 > 50 mmHg |
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name 5 vent settings typically seen postop in COPD pts.
1.FiO2? 2.PEEP? 3.PaCO2? 4.TV? 5.RR? |
1.FiO2 at least 50% to maintain PaO2 60-100 mmHg
2.PEEP only if difficult to maintain PaO2 > 60 (take care b/c can cause more air trapping) 3.PaCO2 levels to maintain pH 7.35-7.45 4.TV 10-15 ml/kg 5.RR 6-10 breaths/min |
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what negative effects do smoking have r/t to surgery? (3)
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1.nicotine - sympathomimetic effects on heart; transient lasting 20-30 min
2.increased carboxyhemoglobin - pulse ox overestimation of SpO2 3.mucous hypersecretion, mucociliary transport impairment, narrowing small airways |
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for what type of surgeries are regional anesthetics traditionally used for? (2)
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1.surgeries where peritoneum will not invaded
2.surgeries on extremities |
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benefit of regionals compared to spinal/epidural for pulmon system?
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less pulmonary complications than with spinal or epidurals
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at which level is regional sensory suppression not good? why?
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above T6
decreases expiratory reserve volume |
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in general anesthesia for COPD pts, what's the disadvantages of:
a.N2O b.inhaled anesthetics c.opioids d.thiopental e.midazolam |
a.N2O = enlargement & rupture of bullae resulting in tension pneumothorax & decreased FiO2
b.inhaled anesthetics = attenuate regional hypoxic pulmonary vasoconstriction leading to right to left intrapulmonary shunting c.opioids = prolonged d.thiopental= prolonged e.midazolam = prolonged |
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what's the overall end goal for ventilation mngmt of COPD - a. Vt & b. RR?
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a. Vt = large (10-15 ml/kg)
b. RR = slow (6-10 b/min) |
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whats the benefit of large Vt & slow RR? (4)
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1.minimizes turbulent flow
2.maintain optimal V/Q matching 3.allow time for venous return to heart 4.complete exhalation minimizing air trapping |
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how soon will postop VC return to preop state?
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10-14 days
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besides COPD, what are some less common causes of expiratory airflow obstruction? (4)
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1.bronchiectasis
2.cystic fibrosis 3.bronchiolitis obliterans 4.tracheal stenosis |
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what expiratory obstructive resp disorder is this?
1.chronic expiratory obstructive resp condition 2.chronic productive cough 3.purulent sputum & massive hemoptysis 4.vascularized granulated tissues 5.irreversible, dilation of bronchus 6.destructive inflammation of bronchial walls |
bronchiectasis
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2 causes of bronchiectasis.
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1.bacterial infections
2.myobacterial infections |
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physical feature of pt w/ bronchiectasis.
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clubbing digits (not found in COPD)
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can surgery be used for bronchiectasis? if so what surgeries?
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yes.
surgical resection of involve lung selective bronchial arterial embolization under radiographic control |
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how much sputum can be produced in pts w/ bronchoiectasis?
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massive hemoptysis > 200 ml over 24 hrs
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what's the anesth mgmt of bronchiectasis surgery?
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double lumen endobronchial tube to prevent spillage of purulent sputum into normal areas of lungs
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what is this?
most common life-shortening autosomal recessive disorder |
cystic fibrosis
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pathophysiology of cystic fibrosis. (4)
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1.mutation on chromosome 7
2.defective chloride ion transport in epithelial cells in lungs, pancreas, liver, GI tract, reproductive organs 3.decreased transport of Na & water 4.dehydration |
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s/s of what?
1.dehydration 2.GI: pancreatic insuffiency; meconium ileus at birth; DM; obstrutctive hepatobiliary tract disease (cirrhosis & portal HTN; malabsorption) 3.GU: obstructive azospermia 4.Resp: coughing, chronic purulent sputum, exertional dyspnea, chronic pansinusitis |
cystic fibrosis
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cystic fibrosis diagnosis.
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sweat chloride concentration ( >80mEq/L)
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what does bronchoalveolar lavage show in cystic fibrosis?
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high neutrophils
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name 3 cystic fibrosis treatment modules.
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1.bronchodilators
a.beta2 b.anticholinergics 2.reduction of viscoelasticity of sputum a.purified recombinant human deoxyribonuclease for digestion 3.antibiotics a.aminoglycoside b.b-lactam (for pseudomonas aeruginosa) |
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what does the anesth mgmt of cystic fibrosis include? (3)
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1.vit K if hepatic fxn poor or malabsorption present
2.volatile agents w/ high O2 3.frequent sxning |
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what is this?
congenital impairment of ciliary activity in resp tract epithelial cells & sperm tails |
primary ciliary dyskinesia
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what conditions are associated w/ ciliary dyskinesia?
1. resp (4) 2. GU (3) 3. organs 4. cardiac (2) |
1.resp: chronic sinusitis, secondary otitis media, productive cough, bronchiectasis
2.GU: male & female infertility; uterine displacement 3.organs: organ inversion 4.cardiac: dextrocardia (reverse ecg); inversion of great vessels |
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in relation to primary ciliary dyskinesia, what is the triad of kartagener syndrome?
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1. chronic sinusitis
2. bronchiectasis 3. situs inversus |
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which population is effected by bronchiolitis obliterans?
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children
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cause of bronchiolitis obliterans?
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respiratory syncytial virus
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what major resp disorder can bronchiolitis obliterans lead to?
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COPD
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what disorders/situations can bronchiolitis obliterans accompany? (4)
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1.viral pneumonia
2.collagen vascular disease (RA) 3.inhalation of N2O ("siol filler's diseas) 4.graft-versus-host disease after bone marrow transplant |
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manifestations of which expiratory obstructive resp disorder?
1.dyspnea 2.nonproductive cough 3.cardiogenic pulmonary edema |
bronchiolitis obliterans
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what is treatment of bronchiolitis obliterans? is it effective?
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corticosteriods to suppress inflammatory rxns
not usually effective |
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what is an extreme example of COPD?
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tracheal stenosis
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causes of tracheal stenosis? (4)
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1.prolonged mechanical ventilation
2.tracheostomy 3.infections 4.systemic hypotension |
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what's the underlying patho of tracheal stenosis?
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a.tracheal mucosal ischemia
b.destruction of cartilaginous rings c.circumferential constricting scar formation |
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how can you minimized occurance of tracheal stenosis?
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high residual volume cuffs on ett to avoid excessive pressure on mucosa
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when will tracheal stenosis become symptomatic?
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when adult trachea diameter < 5 mm
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manifestations of which expiratory obstructive resp disorder?
1.dyspnea prominent at rest 2.use of accessory muscles 3.ineffective cough 4.audible stridor 5.slow breathing 6.inability to increase Vt 7.decreased peak flow rates during exhalation |
tracheal stenosis
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treatments of tracheal stenosis? (2)
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1.tracheal dilation
2.surgical resection of stenotic tracheal segment w/ primary anastomosis |
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during surgery w/ tracheal stenosis, what's the goal for:
a.volative agents and oxygen b.frequency |
a.volatile agents w/ maximum FiO2
b.high frequency |
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what is another inhalational agent not typically used that could be beneficial for tracheal stenosis operations? why?
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helium 50-75%
decreases density of gases; may improve flow thru narrowed tracheal areas |
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what resp disorder does this describe?
resp: chronic sinusitis, secondary otitis media, productive cough, bronchiectasis |
ciliary dyskinesia
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what resp disorder does this describe?
GU: male & female infertility; uterine displacement |
ciliary dyskinesia
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what resp disorder does this describe?
organs: organ inversion |
ciliary dyskinesia
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what resp disorder does this describe?
cardiac: dextrocardia (reverse ecg); inversion of great vessels |
ciliary dyskinesia
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