BioScience I - Quiz 1

Blood Reservoir

Acid Base Balance

Chest Wall Support

Metabolism

Phonation

Ventilation

External Respiration

Internal Respiration

The inspiration and expiration of air from the atmosphere into the lungs.

The exchange of gases between the blood and the cells

The exchange of gases between the lungs and the blood

The production of ATP within the cells

While the patient is sedated insert the tube into the left nose applying a firm pressure to rapidly insert the tube past the nares at a downward angle.

Insert the tube at an upward angle in order to decrease the risk of bleeding, the nare should be pushed inferiorly

With the nose pushed superiorly insert the tube with steady gentle pressure parallel to the roof of the mouth.

Insert the tube gently and with a twisting motion to ease past the turbinates. If the tube gets caught temporarily direct upward and apply firm pressure until you are past.

Basal Skull Fracture

Nasal polyps

Facial Nerve Palsy

Intracranial Infection

Serve as a conduit for air and food and to provide a resonating chamber for speech sounds

To supply the cells of the body with oxygen and remove the carbon dioxide produced by cellular activities

Humidification and filtering of inspired air

Provides the chief support for the larynx

Nasopharynx

Tracheopharynx

Laryngopharynx

Oropharynx

Children are less prone to tissue necrosis from large ETT tubes, adults need softer cuffs to prevent tissue necrosis.

Pediatric cases are generally of a short duration, otherwise a cuffed tube would be used

Cricoid cartilage can form a seal against an ETT tube in children, making cuffed tubes uneccessary.

The much wider vocal cords of adults make extubation more likely so the cuff is used to prevent extubation.

Arytenoid

Corniculate

Cuneiform

Cricoid

Epiglottis

Vocal Cords

Cricoid

Arytenoid

Pharynx

Hyoid Bone

Thyroid Cartilage

Cricoid Cartilage

Aren’t YOU supposed to teach me this stuff?

The ETT will be pulled upward and the pt is at risk for extubation.

The ETT will be pushed further into the trachea, pt at risk for tube to hit carina or go into Right mainstem bronchus.

The ETT should not move, you secured it prior to the procedure.

Epiglottis

Periglottic

Corniculate

Arytenoid

Cricoid

Arytenoid

Thyroid

Epiglottis

It is a fixed structure approximately 12 cm in length

Distance from incisors to carina is roughly 26 cm

Composed of 120 horizontal complete rings

Extends from the Epiglottis to the end of the primary bronchi

Cartilage, smooth muscle

Simple cuboidal, pseudostratified ciliated

Pseudostratified ciliated, simple cuboidal

Cartilage rings, cartilage plates

Pleural

Surfactant

Parietal

Visceral

Right

Left

Both are equal

Right

Left

Both

Right

Left

Both

Mediastinitis

Chylothorax

Paralysis of nerves which innervate diaphragm

Pneumothorax

Diffusion of gases

Protects alveoli from collapsing

Production of surfactant

Segmentalization of alveoli

Internal Respiration

Aerobic Metabolism

Glycolysis

Anaerobic Metabolism

Reducing O2 consumption while increasing CO2 production by ~15% each.

Increased cerebral O2 consumption

Reducing both O2 consumption and CO2 production by ~ 15% each.

Produces hyperthermia which will increase cardiac O2 consumption.

To serve as a conduit for air and food and to provide a resonating chamber for speech sounds

To conduct gas flow to and from the alveoli

Humidification and filtering of inspired air

Provides the chief support for the larynx.

17

19

6

23

17-19

21-23

23-26

11-15

The largest alveoli are found at the bases of the lungs while in upright position.

Size of alveoli is a function of gravity and lung volume.

Walls are symmetrical to allow for maximal gas exchange.

The larger alveoli will have more surfactant than smaller alveoli.

Due to interruption of bronchial circulation to the lungs.

Due to interruption of sympathetic activity while stimulating vagal activity

Due to both phrenic and intercostals nerves being disrupted.

Due to increased likelihood of tension pneumothorax

Constriction, decreases

Dilation, decreases

Dilation, Increases

Constriction, Increases

Changes in intrathoracic pressure

God.

Intermittent positive pressure in the airway

Diaphragmatic relaxation

True

False

True

False

Passive

Active

Dependent

Shortened

Expand, Expand

Collapse, Expand

Expand, Collapse

Collapse, Collapse

Alveolar size

Amount of Surfactant

Patient height

Surface Tension

Surfactant

Angiotensin Converting Enzyme

Carbon Dioxide

Pleural WD40

Elastic Recoil

Compliance

Diaphragmatic Excursion

Surfactant

Defined as the lung volume at the end of NORMAL exhalation.

About 2300 ml in normal adult.

Composed of Expiratory reserve volume + Inspiratory reserve volume

Directly related to patient height

Composed of Expiratory Reserve Volume + Residual Volume

Volume of gas that can be exhaled following Maximal inspiration

The mean volume of total lung capacity

Volume at which small airways close in dependent parts of lungs

Vital Capacity

Total Lung Capacity

Functional Residual Capacity

Zero Long Volume

Body habitus

Gender

Respiratory muscle strength

Chest-Lung Compliance

2400 ml

6000 ml

3600 ml

3000 ml

Laminar

Turbulent

Transitional

A mix of laminar and turbulent

Diaphragm

Intercostal muscles

Abdominal muscles

Accessory muscles

True

False

Increased

Decreased

Unchanged

4.5 L

6 L

5.4 L

3.8 L

Physiologic Dead Space

Alveolar Dead Space

Ventilatory Dead Space

Anatomic Dead Space

Will increase pulmonary blood volume

Will decrease pulmonary blood volume

Will have no effect

Placing the pt in Lithotomy position

Placing pt in upright position

Placing pt in Trendelenburg

Administering Ephedrine

Systemic Capacitance

Perfusion Reflex

Hypoxic Pulmonary Vasoconstriction

Baroreceptor reflex

Normal function of lungs

Decreased Perfusion

Pulm Emboli

Decreased Ventilation

Normal function of lungs

Decreased Perfusion

Hypoxic Pulmonary Vasoconstriction

Decreased Ventilation

True

False

Increased Dead Space

Increased FRC

Hypoventilation

Increased Pulm Shunting

Decrease delivery

Increase delivery

Unaffected due to compensatory mechanisms

Shift to Left and increase affinity of Hgb for O2

Shift to Left and decrease affinity of Hgb for O2

Shift to Right and decrease affinity of Hgb for O2

Shift to Right and increase affinity of Hgb for O2

Carbon Monoxide Poisoning

Fetal Hemoglobin

PH 7.50

Increased 2,3-DPG levels

O2 remaining in lungs

O2 bound to Hgb

O2 dissolved in body fluid

O2 within tissues

To blow off excess CO2

To increase oxygen stores

To shift oxygen hemoglobin dissociation curve to the left.

To increase FRC

True

False

Pontine Area

Central Chemoreceptors

Medulla

MidBrain

A protective reflex which diverts blood flow away from poorly ventilated or atelectic areas to minimize pulmonary shunting.

Compensates for decreased O2 affinity for Hgb in a Right shift by producing more RBC’s.

Responds to arterial changes in O2, CO2, and H concentrations to change respiratory rate.

Senses distention in lungs to prevent overinflation.

Inhibition of Phosphodiesterase

Surfactant Synthesis

Conversion of Angiotensin 1 to Angiotensin 2

Infection Control

Greater, lower

Greater, Greater

Lower, Greater

None of above

Mrs. Kuehm who has been a smoker for 15 yrs, 1 pack per day, but currently has no pulmonary disease

Mr. Dent who is 78 yr old obese diabetic having a minor procedure

Mrs. Vayo who is having open heart surgery today.

Mr. Brachle who is having ankle and knee reconstructions following an MVA. Procedure predicted to take >3 hours.

Preexisting Pulmonary Conditions

Thoracic or Upper Abdominal Surgery

Prolonged General Anesthesia

Prone or Lateral Decubitus Position

Decreased FEV1/FVC ratio and resistance to airflow

Lung volumes decreased with normal FEV1/FVC ratio

Manifested as sudden trachypnea, chest pain or hemoptysis

Both A & B

Great! She is improving, this is a good sign.

Crap, the obstruction has become severe, she is getting worse.

Not enough information to determine her status.

The presence of a chronic productive cough most days of the month.

Increases in FRC, RV, and TLC as well as pursed lip breathing.

Insidious onset, chronic inflammation of alveolar walls and progressive pulmonary fibrosis.

Recurrent episodes of wheezing, breathlessness, chest tightness, and cough.

At all levels of Lower Airway

Only in the alveoli and terminal bronchioles

At all levels of the upper airway

In the main stem bronchi

Cancel the procedure until the patient is stabilized

Give the patient a respiratory treatment prior to surgery, the monitor closely during surgery

Induce the patient and then give treatment if symptoms occur

Induce with Propofol & Atracurium to reduce possibility of bronchospasm.

Inform the surgeon the patient is showing signs of malignant hyperthermia and to close up.

Administer an albuterol treatment to the patient.

Turn your Sevo up to deepen anesthetic depth.

Give IV hydrocortisone & glyco.

The presence of a chronic productive cough most days of the month.

Increases in FRC, RV, and TLC as well as pursed lip breathing.

Insidious onset, chronic inflammation of alveolar walls and progressive pulmonary fibrosis.

Recurrent episodes of wheezing, breathlessness, chest tightness, and cough.

The presence of a chronic productive cough most days of the month.

Increases in FRC, RV, and TLC as well as pursed lip breathing.

Insidious onset, chronic inflammation of alveolar walls and progressive pulmonary fibrosis.

Recurrent episodes of wheezing, breathlessness, chest tightness, and cough.

Beta Adrenergic Agonists

Broad spectrum antibiotics

Anticholinergics

Oxygen

Give Lasix, pt is hypervolemic

Give vasodilators, RV failure is worsening

Give albumin to help prevent third spacing

Give Inotropic agents to increase the CI

2-4

6-8

10-12

1-2

COPD

Emphysema

Smoking

Age

Nitrous oxide should be avoided in those with pulmonary HTN.

Ventilation should be controlled with small to moderate tidal volumes and slow rates

Pre-op interventions may decrease the incidence of post-op complications

Pre-oxygenation should be avoided due to the hypoxic respiratory drive of the COPD patient.

Hypoxia is main respiratory drive

Respiratory drive initiated by PCO2

Intrinsic respiratory rate will be much more rapid

HPV reflex is absent.

Increase ETCO2

Decrease ETCO2

No effect on ETCO2

The presence of a chronic productive cough most days of the month.

Increases in FRC, RV, and TLC as well as pursed lip breathing.

Decreased lung compliance and lung volumes but a normal FEV1/FVC ratio

Recurrent episodes of wheezing, breathlessness, chest tightness, and cough.

ARDS

Pulmonary Edema

Pneumonia

Asthma

Increased lung permeability and fluid in lungs

Fibrosis of pulmonary tissue

Increased dead space cause by air trapping

Lack of surfactant leading to collapsed alveoli

Vt 600 RR 14

Vt 360 RR 16

Vt 420 RR 10

Vt 550 RR 12

The presence of a chronic productive cough most days of the month.

Increases in FRC, RV, and TLC as well as pursed lip breathing.

Insidious onset, chronic inflammation of alveolar walls and progressive pulmonary fibrosis.

Recurrent episodes of wheezing, breathlessness, chest tightness, and cough.

Patient will have high levels of methemoglobin

Patient should be placed on 100% O2 during the procedure

Patient will be more susceptible to Pulmonary Embolism

Inspired FiO2 should kept to a minimum (30%) or less.

Pulmonary Embolism

Acute Asthma Attack

Pulmonary Edema

Pnuemonia

Increased Pulmonary shunting

Increased ETCO2

Low V/Q ratio

Elevated CVP & hypotension

Do you take medication to control your asthma and how often?

Have you been hospitalized within the last 2 yrs for asthma related problems?

When was your last attack? About how often do you have attacks?

All the above

True

False

Aspirin

Morphine

Fentanyl

Atracurium

True

False

True

False

PH 7.27 PaCO2 58 PaO2 60 HCO3 26

PH 7.45 PaCO2 49 PaO2 86 HCO3 31

PH 7.38 PaCO2 38 PaO2 90 HCO3 24

PH 7.52 PaCO2 22 PaO2 70 HCO3 25

Diabetic Acidosis

COPD

Neuromuscular abnormalities

Cardiopulmonary arrest

Pulmonary embolism

Pulmonary edema

Pneumothorax

Fever

NG suctioning

Diuretic Therapy

Severe Diarrhea

Severe vomiting

Shock

Renal failure

Diabetic Acidosis

Cushings Disease

PH 7.54 CO2 28 HCO3 22

PH 7.20 CO2 60 HCO3 26

PH 7.62 CO2 45 HCO3 33

PH 7.18 CO2 35 HCO3 15

PH 7.54 CO2 28 HCO3 22

PH 7.20 CO2 60 HCO3 26

PH 7.62 CO2 45 HCO3 33

PH 7.18 CO2 35 HCO3 15

PH 7.54 CO2 28 HCO3 22

PH 7.20 CO2 60 HCO3 26

PH 7.62 CO2 45 HCO3 33

PH 7.18 CO2 35 HCO3 15

PH 7.54 CO2 28 HCO3 22

PH 7.20 CO2 60 HCO3 26

PH 7.62 CO2 45 HCO3 33

PH 7.18 CO2 35 HCO3 15

Partially Compensated Metabolic Acidosis

Compensated Respiratory Acidosis

Compensated Metabolic Alkalosis

Partially compensated respiratory alkalosis

Partially Compensated Metabolic Acidosis

Compensated metabolic alkalosis

Partially compensated respiratory alkalosis

Compensated respiratory acidosis

Partially Compensated Metabolic Acidosis

Compensated metabolic alkalosis

Partially compensated respiratory alkalosis

Compensated respiratory acidosis

Partially Compensated Metabolic Acidosis

Compensated metabolic alkalosis

Partially compensated respiratory alkalosis

Compensated respiratory acidosis

Respiratory Acidosis

Respiratory Alkalosis

Metabolic Acidosis

Metabolic Alkalosis

Normal ABG

Respiratory Acidosis

Respiratory Alkalosis

Metabolic Acidosis

Metabolic Alkalosis

Normal ABG

Respiratory Acidosis

Respiratory Alkalosis

Metabolic Acidosis

Metabolic Alkalosis

Normal ABG

Respiratory Acidosis

Respiratory Alkalosis

Metabolic Acidosis

Metabolic Alkalosis

Normal ABG

Respiratory Acidosis

Respiratory Alkalosis

Metabolic Acidosis

Metabolic Alkalosis

Normal ABG

Dependent, independent

Independent, dependent

Dependent, dependent

Independent, independent

70%

80%

90%

50%

Low forced midexpiratory flow

Reduced FEV1/FVC ratio

Decreased lung compliance

Increased airway resistance

Normal Forced midexpiratory flow

Normal FEV1/FVC ratio

Decreased FEV1 & FVC

Increased airway resistance

Dear god, did that giraffe cuss?

Laura, we are seriously beginning to questions your mental stability.

HA HA HA HA

All the above

Peribulbar block

Subtenon block

Retrobulbar block

Topical anesthesia

Succhinylcholine may be used within 20 minutes of forced duction testing as long as pretreatment with a nondepolarizer is used

Succhinylcholine causes increased intraocular pressure due to contraction of intraocular muscles, causing a false forced duction result

The increase in potassium associated with the use of succhinylcholine may produce transient blindness if used during forced duction testing

Succhinylcholine may potentiate the oculocardiac reflex and is thus contraindicated during forced duction testing

Asking the surgeon to create more traction on the extraocular muscles

Utilizing sevoflurane rather than desflurane during maintenance

Utilizing vecuronium rather than rocuronium to paralyze the patient

Using atropine 0.02 mg/kg IV preoperatively

General Endotrachial Intubation Anesthesia (GETA) – Appendectomy necessitates patient paralysis throughout the procedure.

LMA – pt will not be paralyzed, which allows for spontaneous ventilation.

RSI with endotrachial intubation – appendectomy usually an emergency procedure, and these patients must be treated as a full stomach

Mask ventilation – procedure is relatively short and can be managed with inhalational anesthetics via mask ventilation

Insertion of an NGT allows decompression of the stomach, decreasing the risk of aspiration

According to AANA’s standards, all patients under general anesthesia must have an NGT inserted.

Appendectomy is usually an emergent procedure, and patients undergoing this surgery are usually treated as a full stomach

All of the above are correct

Fluid and electrolyte replacement secondary to concomitant vomiting, fever, and decreased oral intake.

Administration of antibiotics, especially if there possible perforation and contamination into the abdominal cavity.

Lateral decubitus positioning – pressure points must be padded, arms supported by pillow and armboard, axilla roll in place to prevent brachial plexus injury.

Both a & b

Become tachycardic and hypertensive

Become tachycardic and hypotensive

Become bradycardic and hypertensive

Become bradycardic and hypotensive

To obtain a full set of labs including, CBC, BMP, PT/INR. EKG, & CXR

To ensure the patient was NPO for a minimum of 4 hours.

To make the surgeon wait an extra 30 minutes because you don’t like him

Note any pre-existing sensory or motor defects

ORIF is required for closed unstable fractures unable to improve with conservative therapy

Most commonly seen in young, healthy individuals.

EBL is moderate

Can use a combination of regional and general anesthesia