Respiratory Assessment
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Questions and Answers

What are the primary functions of the upper airway?

  • Facilitating laminar flow and conduit for air
  • Tissue hydration and trapping of pathogens
  • Warming and humidification of inspired gases
  • All of the above (correct)

    • What determines whether airflow is laminar or turbulent?

  • Viscosity of gas
  • Reynold's number (correct)
  • Density of gas
  • Cross-sectional area of airways

    • At which level of the airways do they lose all cartilage?

  • Bronchi
  • Bronchioles (correct)
  • Trachea
  • Alveoli

    • What is the effect of increasing division of airways on airflow resistance?

    <p>Resistance decreases</p> Signup and view all the answers

    Which type of alveolar cell is responsible for gas exchange?

    <p>Type 1 squamous epithelial</p> Signup and view all the answers

    What should a functional assessment of the respiratory system include?

    <p>Evaluation of respiratory mechanics, gas exchange, and cardiopulmonary interaction</p> Signup and view all the answers

    What is the typical duration for airway hyperreactivity to resolve after an upper respiratory infection?

    <p>6+ weeks</p> Signup and view all the answers

    When providing anesthesia care for a patient with an upper airway infection, what strategies might reduce the risk of adverse airway events?

    <p>all of the above</p> Signup and view all the answers

    Which of the following medications is NOT typically used to treat asthma?

    <p>Antibiotics</p> Signup and view all the answers

    What is the primary method used to assess the severity of COPD?

    <p>Pulmonary function tests (PFTs)</p> Signup and view all the answers

    What is the sum of ERV and RV in a lung?

    <p>FRC</p> Signup and view all the answers

    Which of the following lung volumes is not a part of vital capacity?

    <p>Residual volume</p> Signup and view all the answers

    What is the minimum VO2 max required for a post-thoracotomy patient to have a lower risk of poor outcomes?

    <p>15 mL/kg/min</p> Signup and view all the answers

    What is the most common cause of upper respiratory infections in children?

    <p>Viral or bacterial nasopharyngitis</p> Signup and view all the answers

    What is the percentage of upper respiratory infections caused by viral or bacterial nasopharyngitis?

    <p>95%</p> Signup and view all the answers

    What is the primary mechanism underlying desaturation in obese patients during anesthesia?

    <p>Decreased functional residual capacity</p> Signup and view all the answers

    What is the primary indicator of pulmonary hypertension?

    <p>Mean PAP &gt;25 mmHg or PAOP &gt;15 mmHg</p> Signup and view all the answers

    Which of the following is NOT a risk factor for obstructive sleep apnea?

    <p>Smoking</p> Signup and view all the answers

    What is the primary benefit of applying PEEP during anesthesia in morbidly obese patients?

    <p>Reducing atelectasis</p> Signup and view all the answers

    What percentage of patients with pulmonary hypertension experience dyspnea?

    <p>98%</p> Signup and view all the answers

    What is the primary indicator of severe pulmonary hypertension?

    <p>Pre-syncopal or syncopal episodes</p> Signup and view all the answers

    What is the primary diagnostic test for identifying valvular disorders, right ventricular function abnormalities, and left ventricular failure in pulmonary hypertensive patients?

    <p>Echocardiogram</p> Signup and view all the answers

    What is the primary benefit of smoking cessation in terms of wound healing?

    <p>Lowered levels of toxic substance</p> Signup and view all the answers

    What is the primary implication of Schamroth's sign?

    <p>Underlying systemic disorders such as chronic hypoxia</p> Signup and view all the answers

    What is the recommended time frame for smoking cessation before surgery?

    <p>3-4 weeks</p> Signup and view all the answers

    What is the primary mechanism by which smoking cessation improves mitochondrial function?

    <p>Decreased cyanide levels</p> Signup and view all the answers

    What organs tend to obstruct the upper airway when the patient is under the influence of anesthesia?

    <p>Tongue and soft palate</p> Signup and view all the answers

    What is airflow directly proportional to, and inversely proportional to?

    <p>Directly proportional to the pressure gradient and inversely proportional to the resistance</p> Signup and view all the answers

    Laminar flow resistance primarily reflects what property of gas?

    <p>Viscosity</p> Signup and view all the answers

    Turbulent flow reflects what property of gas?

    <p>Density</p> Signup and view all the answers

    What type of airflow potentiates the trapping of inhaled particulate matter?

    <p>Turbulent airflow</p> Signup and view all the answers

    Where does the trachea terminate?

    <p>At the carina, bifurcating into the right and left primary bronchi</p> Signup and view all the answers

    What is unique about the right mainstem bronchus?

    <p>It is shorter and wider than the left mainstem bronchus</p> Signup and view all the answers

    Which generations of airways are used for conducting air?

    <p>1-16th</p> Signup and view all the answers

    What is the definition of an acinus in the context of the respiratory system?

    <p>A type of lung tissue containing air sacs made up with up to 2000 alveoli</p> Signup and view all the answers

    What is the function of Type II alveolar cells?

    <p>To produce surfactant</p> Signup and view all the answers

    What are the key features of a lung exam?

    <p>Inspection, palpation, percussion, and auscultation</p> Signup and view all the answers

    What is the definition of total lung capacity?

    <p>The maximum amount of air that can be exhaled from the lungs after a maximal inhalation.</p> Signup and view all the answers

    What is the Inspiratory Reserve Volume (IRV)?

    <p>The largest amount of air that can be inhaled after normal inhalation.</p> Signup and view all the answers

    Which three lung volumes are included in vital capacity?

    <p>Expiratory reserve volume, tidal volume, and inspiratory reserve volume</p> Signup and view all the answers

    What lung volumes cannot be determined by spirometry?

    <p>FRC, TLC, and RV</p> Signup and view all the answers

    What is the most useful test of gas exchange capacity?

    <p>Diffusing capacity for carbon monoxide</p> Signup and view all the answers

    What does DLCO (diffusion capacity of the lungs for carbon monoxide) correlate with?

    <p>The total functioning surface area of the alveolar-capillary interface</p> Signup and view all the answers

    Why is the DLCO test useful in respiratory assessment?

    <p>CO has high affinity for Hgb so it follows the same path as oxygen to bind with hemoglobin</p> Signup and view all the answers

    6 minute walk test correlates with VO2 max

    <p>True</p> Signup and view all the answers

    The ability to climb 5 flights of stairs is approximately VO2 max > 20

    <p>True</p> Signup and view all the answers

    What are the common symptoms of an Upper Respiratory Infection (URI)?

    <p>cough, sneezing, rhinorrhea</p> Signup and view all the answers

    Bacterial URIs produce more serious symptoms

    <p>True</p> Signup and view all the answers

    Diagnosis of URIs are usually based on cultures and labs tests

    <p>False</p> Signup and view all the answers

    Children with URIs are at an increased risk of which respiratory complications?

    <p>Transient hypoxemia and laryngospasm</p> Signup and view all the answers

    What effects do surgery and anesthesia have on the immune system?

    <p>They suppress the immune system.</p> Signup and view all the answers

    What is the preferred airway management technique when a patient has an upper respiratory tract infection (URI)?

    <p>LMA</p> Signup and view all the answers

    What is COPD?

    <p>A respiratory disease characterized by chronic inflammation of the airways that can be partially reversible</p> Signup and view all the answers

    What are some common causes of Chronic Obstructive Pulmonary Disease (COPD)?

    <p>Cigarette smoking/pollutant exposure, Alpha-1 antitrypsin deficiency, chronic infections, and longstanding asthma</p> Signup and view all the answers

    What differentiates asthma from COPD?

    <p>Reversible airflow obstruction</p> Signup and view all the answers

    Are patients with mild well-controlled asthma at an increased perioperative risk?

    <p>False</p> Signup and view all the answers

    During assessment, asthma patients should be queried about:

    <p>All of the above</p> Signup and view all the answers

    In asthma patients, what can ET intubation cause?

    <p>A and B</p> Signup and view all the answers

    How is the severity of COPD typically measured?

    <p>Forced Expiratory Volume (FEV1) and Forced Vital Capacity (FVC)</p> Signup and view all the answers

    What FEV1/FVC ratio is needed to be diagnosed with COPD?

    <p>Less than 0.7</p> Signup and view all the answers

    At which FEV1/FVC ratio is moderate COPD graded?

    <p>&gt;0.5 and &lt;0.8</p> Signup and view all the answers

    What is the FEV1/FVC ratio?

    <p>A ratio of forced expiratory volume to forced vital capacity</p> Signup and view all the answers

    How does COPD affect FEV1?

    <p>It decreases FEV1 due to obstruction</p> Signup and view all the answers

    How does COPD affect FRC (Functional Residual Capacity)?

    <p>It increases FRC due to reduced airflow, lost elasticity, and over expansion</p> Signup and view all the answers

    What is the DLC0 in COPD?

    <p>Reduced</p> Signup and view all the answers

    Is a chest x-ray useful for the routine assessment of asthma and COPD patients?

    <p>False</p> Signup and view all the answers

    Is it true that pulmonary hypertension medications should be continued on the day of surgery?

    <p>True</p> Signup and view all the answers

    What pulmonary changes are present in restrictive lung disease?

    <p>Decreased lung compliance and decreased functional residual capacity</p> Signup and view all the answers

    What pulmonary symptoms are typically present in obstructive lung disease?

    <p>Increased lung volume due to air trapping, increased airway resistance</p> Signup and view all the answers

    What are the FEV1 and FVC in restrictive lung disease?

    <p>Both FEV1 and FVC are decreased</p> Signup and view all the answers

    The FEV1/FVC ratio in restrictive lung disease is increased

    <p>False</p> Signup and view all the answers

    How many bronchi does the right upper lobe bronchus typically give off?

    <p>3</p> Signup and view all the answers

    You can measure RV using a spirometer

    <p>False</p> Signup and view all the answers

    Is obesity the most common restrictive lung disease?

    <p>True</p> Signup and view all the answers

    The decreased in FRC in obese patients also decreases the tendency to desaturate during anesthesia procedures

    <p>False</p> Signup and view all the answers

    What should be the goal of all interventions used during anesthesia procedures with obese patients?

    <p>Minimizing decreases in the FRC</p> Signup and view all the answers

    What is the functional residual capacity (FRC)?

    <p>ERV+RV</p> Signup and view all the answers

    How is the severity of Obstructive Sleep Apnea (OSA) typically measured?

    <p>Using the Apnea-Hypopnea Index (AHI)</p> Signup and view all the answers

    What is the defining feature of the upper airway in obstructive sleep apnea (OSA)?

    <p>Intermittent airway obstruction</p> Signup and view all the answers

    What is used preoperatively to assess OSA (obstructive sleep apnea)?

    <p>STOP-BANG questionnaire</p> Signup and view all the answers

    OSA patients tolerate the respiratory depressant effects of opioids due to their tolerance of hypoxia

    <p>False</p> Signup and view all the answers

    Patients with pulmonary hypertension have a high rate of perioperative morbidity and mortality

    <p>True</p> Signup and view all the answers

    Moderate to severe pulmonary hypertension increases the risk of which disease?

    <p>Cor pulmonale/right-sided heart failure</p> Signup and view all the answers

    Pulmonary hypertension causes a decreased sympathetic tone

    <p>False</p> Signup and view all the answers

    Is opioid administration well tolerated in patients with cor pulmonale?

    <p>False</p> Signup and view all the answers

    What is a common cause of pulmonary hypertension?

    <p>All of the above</p> Signup and view all the answers

    In pulmonary hypertension, syncopal episodes indicate what about the disease progression?

    <p>Severe disease</p> Signup and view all the answers

    What are the common signs and symptoms of pulmonary hypertension?

    <p>Dyspnea, metabolic acidosis, hypoxemia, increase PVR</p> Signup and view all the answers

    What is unique about heart sounds in pulmonary hypertension?

    <p>Split S2 sound, RV heave</p> Signup and view all the answers

    What type of murmur may be heard in pulmonary hypertension?

    <p>Tricuspid regurgitation murmur</p> Signup and view all the answers

    What EKG changes are present in pulmonary hypertension?

    <p>Right axis deviation, RBBB, RVH, tall peaked R waves in V1-V2, peaked P waves in inferior leads</p> Signup and view all the answers

    Mild pulmonary hypertension does not influence anesthetic management

    <p>True</p> Signup and view all the answers

    Consulting with a patient's pulmonologist preoperatively is not necessary unless the patient has severe pulmonary hypertension

    <p>False</p> Signup and view all the answers

    What is the effect of smoking on coronary blood flow?

    <p>It decreases coronary blood flow</p> Signup and view all the answers

    What is the effect of smoking on macrophage function?

    <p>Decreases their ability to fight infection</p> Signup and view all the answers

    What is the mechanism by which vascular relaxation occurs after the cessation of smoking?

    <p>Decreased levels of nicotine</p> Signup and view all the answers

    What are some risks of pulmonary complications during surgery?

    <p>All of the above</p> Signup and view all the answers

    How do you calculate BMI?

    <p>Weight in kg / height in meters</p> Signup and view all the answers

    Can chronic dyspnea of unclear etiology usually be attributed to asthma, COPD, interstitial lung disease, or cardiac dysfunction?

    <p>True</p> Signup and view all the answers

    What can increase the risk of right heart failure in a pulmonary hypertension patient?

    <p>All of the above</p> Signup and view all the answers

    What does FEV1 represent in respiratory assessment?

    <p>Forced Expiratory Volume at 1 second</p> Signup and view all the answers

    What is FVC?

    <p>Forced Vital Capacity, the maximum volume of air that can be exhaled from the lungs</p> Signup and view all the answers

    Wheezing is specific to asthma

    <p>False</p> Signup and view all the answers

    What cartilage does the trachea originate from?

    <p>Cricoid cartilage</p> Signup and view all the answers

    LMA is preferred in instances of high risk of broncho or laryngospasm

    <p>True</p> Signup and view all the answers

    Resistance = 8 * length * viscosity / (pi*r^4)

    <p>True</p> Signup and view all the answers

    Study Notes

    Respiratory Assessment

    • The upper airway has three main functions: conduit for inhalation and exhalation of air, warming and humidification of inspired gases, and tissue hydration and trapping of pathogens via mucous membranes.

    Airway Resistance

    • Airway resistance is affected by laminar flow (smooth, efficient gas exchange) and turbulent flow (chaotic, trapping inhaled particulate matter).
    • Reynold's number determines whether flow is laminar or turbulent.

    Trachea and Bronchi

    • The trachea terminates at the carina (bifurcation).
    • The right upper bronchus gives off three segmental bronchi.

    Airways and Cartilage

    • Airways lose all cartilage at the level of bronchioles.

    Alveolar Cells and Functions

    • There are three types of alveolar cells: Type 1 (squamous epithelial, for gas exchange), Type 2 (produce surfactant), and Alveolar macrophages (phagocytize foreign objects).

    Functional Assessment of Respiratory System

    • Functional assessment should include evaluation of three functions: respiratory mechanics, gas exchange, and cardiopulmonary interaction.

    Lung Capacities and Volumes

    • FRC (functional residual capacity) is the volume after normal exhalation.
    • TLC (total lung capacity) is the sum of IRV, TV, and FRC.
    • RV (residual volume) is the volume of air to keep lungs inflated.
    • VC (vital capacity) includes inspiratory reserve volume, TV, and expiratory reserve volume.

    Diffusion Capacity and CO

    • Diffusion capacity for carbon monoxide (CO) is the most useful test of alveolar gas exchange.
    • CO has high affinity for Hgb, following the same path as oxygen to bind with hemoglobin.

    Post-Thoracotomy Patients

    • Patients are at risk for poorer post-thoracotomy outcomes if their VO2 max is < 15 mL/kg/min.
    • The 6-minute walk test correlates well with VO2 max.

    Upper Respiratory Infection

    • 95% of URIs are due to viral or bacterial nasopharyngitis.
    • Symptoms include non-productive cough, sneezing, and rhinorrhea.
    • Four risk factors associated with URI that increase the frequency of adverse events under anesthesia: fever, purulent rhinitis, productive cough, and rhonchi.

    Asthma

    • Asthma is characterized by chronic airway inflammation, variable expiratory airflow limitation, SOB, chest tightness, and cough.
    • Three classes of medications an asthma patient may be taking: inhaled/oral steroids, beta2 agonists, and antibiotics.

    COPD

    • Five exposures likely to be associated with provoking COPD: smoking, environmental pollutants, chronic infections, longstanding asthma, and alpha1 antitrypsin deficiency.
    • Measures to assess severity of COPD include spirometry and lung volumes.

    Obstructive Sleep Apnea

    • Risk factors for OSA: snoring, daytime sleepiness, hypertension, obesity, and family history.
    • The Apnea-Hypopnea Index measures the number of apneic-hypopneic episodes per hour of sleep.
    • Three airway management tasks that may be more difficult in OSA patients: mask ventilation, direct laryngoscopy, and ET placement.

    Pulmonary Hypertension

    • Pulmonary hypertension is defined by mean PAP >25 mmHg or PAOP >15 mmHg.
    • Five events that can increase the risk of right heart failure in PH patients: hypoxia, hypercarbia, administration of vasoconstrictors, increased sympathetic tone, and increased PVR.

    Tobacco Smoking

    • Five complications of tobacco smoking: decreased macrophage function, impairment of coronary blood flow, vascular endothelial dysfunction, hypertension, and respiratory complications.
    • Ideally, cessation of smoking should occur 3-4 weeks prior to surgery.
    • Four benefits of smoking cessation: lowered CO levels, levels of toxic substances, cyanide levels, and vascular relaxation.

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