PULMONARY.txt

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Anonymous
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199829
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PULMONARY.txt
Updated:
2013-02-11 18:17:21
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COEX1
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  1. WHAT IS THE DILEMMA WITH PROVIDING ANESTHESIA FOR SOMEONE WITH AN UPPER RESP INFECTION?
    THE CHALLENGE IS TO CANCEL THE PROCEDURE OR PRESS FORWARD. THE PROCEDURE MAY BE IMPERATIVE TO IMPROVE THE UNDERLYING PROBLEM FOR WHICH THE URI IS MANIFESTED
  2. IF THE CASE IS ELECTIVE, WHAT TIME FRAME IS APPROPRIATE TO POSTPONE THE PROCEDURE TO REDUCE THE RISK OF INCREASED AIRWAY REACTIVITY?
    4-6 WEEKS
  3. WHAT IS THE MAJOR RISK FOR NOT POSTPONING A PROCEDURE FOR SOMEONE WITH URI SYMPTOMS SUCH AS FEVER, PRODUCTIVE COUGH AND RHONCHI?
    INCREASED POSTOP AIRWAY EXACERBATION AND COMPROMISE
  4. CONCERNING INTRAOPERATIVE MANAGEMENT OF THE PATIENT WITH POTENTIALLY REACTIVE AIRWAY WHAT ARE 3 INTERVENTIONS THAT CAN REDUCE ADVERSE OUTCOMES?
    • REDUCE AIRWAY MANIPULATION
    • PREOP BRONCHODILATORS
    • ANTIMUSCARINICS (TO DRY UP SECRETIONS)
  5. NAME 4 COMMON SYMPTOMS OF ASTHMA.
    • WHEEZING
    • RETRACTIONS
    • INCREASED WORK OF BREATHING
    • NON PRODUCTIVE COUGH
  6. LIST 4 COMMON TRIGGERS FOR AN ASTHMATIC EVENT.
    • ALLERGY
    • DRUG INDUCED
    • EXERCISE
    • STRESS
    • VAGAL TONE
  7. WHAT IS THE ALTERATION IN FEV1 SEEN WITH ASTHMATICS?
    REDUCED
  8. WHAT TYPE OF FLOW VOLUME IS ASSOCIATED WITH ASTHMA?
    OBSTRUCTIVE PATTERN
  9. REGARDING ASTHMA TREATMENT, LIST 3 MEDICATIONS THAT CAN ALLEVIATE SYMPTOMS.
    • BETA 2 AGONISTS (ALBUTEROL)
    • THEOPHYLLINE (INCREASES cAMP CAUSING BRONCHODILATION)
    • ANTI-INFLAMMATORY (STEROIDS, CROMOLYN)
  10. NAME 3 TESTS THAT SHOULD BE CONSIDERED IN THE PREOPERATIVE ASSESSMENT OF AN ASTHMATIC.
    • PFT
    • BASELINE ABG
    • CHEST XRAY
  11. YOU HAVE JUST INDUCED YOUR PATIENT WHO HAS CHRONIC ASTHMA. THEY HAVE INTRACTABLE HYPOTENSION NOT RESPONDING TO YOUR INTERVENTIONS. WHAT SHOULD YOU CONSIDER NOW?
    CONSIDER THAT THE PATIENT HAS ADRENAL SUPPRESSION AND ADMINISTER STEROIDS.
  12. NAME 3 MEDICATIONS/AGENTS THAT MAY NOT BE THE BEST OF CHOICE FOR A PATIENT WITH ASTHMA.
    • MORPHINE
    • STP
    • ATRICURIUM
    • DESFLURANE
  13. WHAT VENTILATION PARAMETER MAY NEED TO BE INCREASED TO ALLOW THE ASTHMATIC THE CHANCE TO EXHALE FULLY WHILE ON THE VENTILATOR?
    EXPIRATORY TIME
  14. NAME 2 INTERVENTIONS ONE CAN TAKE TO ALLEVIATE BRONCHOSPASM INTRAOPERTIVELY?
    • DEEPEN THE ANESTHETIC
    • ADMIN BETA 2 AGONIST
  15. WHAT IS THE MOA OF ALBUTEROL FOR RELIEVING BRONCHOSPASM?
    BINDS TO BETA 2 RECEPTORS CAUSING AN INCREASE IN cAMP THAT REDUCES INTRACELLULAR CALCIUM. THIS REDUCES SMOOTH MUSCLE CONTRACTION
  16. WHAT TYPE OF RESP DISEASE ARE CHRONIC BRONCHITIS AND EMPHYSEMA?
    CHRONIC OBSTRUCTIVE DISEASE
  17. WHAT IS THE DIFFERENCE IN TERMS OF PAO2, HEMATOCRIT, DIFFUSING CAPACITY AND RIGHT HEART FAILURE IN BRONCHITIS AND EMPHYSEMA?
    • IN BRONCHITIS PAO2 IS DECREASED MORE THAN EMPHYSEMA
    • IN BRONCHITIS HEMATOCRIT IS INCREASED AND NORMAL IN EMPHYSEMA
    • DIFFUSING CAPACITY IS NORMAL IS BRONCHITIS BUT DECREASED IN EMPHYSEMA
    • MARKED RIGHT HEART FAILURE IN BRONCHITIS NOT EMPHYSEMA
  18. LIST 4 CLINICAL INDICATORS THAT WOULD REQUIRE CONSULT WITH PULMONARY MEDICINE DURING THE PREOP ASSESSMENT.
    • HYPOXEMIA ON ROOM AIR
    • PREVIOUS PNEUMONECTOMY
    • SERUM BICARB GREATER THAN 33
    • PACO2 GREATER THAN 50
  19. WHY IS NITROUS OXIDE NOT A GOOD CHOICE OF AGENT FOR THE PATIENT WITH COPD?
    IT MAY RUPTURE BULLAE AND CAUSE PTX
  20. WHY SHOULD SPECIAL BE TAKEN WITH OPIODS AND THOSE WITH COPD?
    THEY HAVE SLOWER ELIMINATION OF OPIOIDS AND COULD HAVE FURTHER COMPLICATION WITH RESPONSE WITH CO2
  21. WHAT FEV1/FVS RATIO WARRANTS MECHANICAL VENTILATION?
    LESS 50% OR PACO2 >50MMHG
  22. WHAT SIZE ETT IS MOST APPROPRIATE IS YOUR PATIENT WITH COPD HAS WORSENING RESPIRATORY STATUS NECESSITATING INTUBATION?
    THE LARGEST ONE YOU CAN SAFELY PLACE. THIS WILL FACILITATE FUTURE BRONCHOSCOPIES AND REDUCE AIRWAY RESISTANCE WITH PPV
  23. RESTRICTIVE LUNG DISEASE HAS 2 FORMS, WHAT ARE THEY?
    • INTRINSIC
    • EXTRINSIC
  24. INTRINSIC LUNG DISEASE IS CHARACTERIZED WHAT? WHAT IS MOST COMMON FORM OF DESTRUCTION?
    • PHYSICAL CHANGES TO LUNG TISSUE
    • FIBROSIS
  25. THIS FORM OF INTRINSIC LUNG DISEASE IS CAUSED BY GRANULATION OF LUNG TISSUE AND HAS SEVERAL TYPES SUCH AS OCULAR, MYOCARDIAL AND LARYNGEAL?
    SARCOIDOSIS
  26. Extrinsic restrictive lung disease is caused by 2 general processes. What are they?
    external compression of the thorax or loss of muscle tone.
  27. NAME 3 CONITIONS COMMONLY ASSOCIATED WITH EXTRINSIC LUNG DISEASE.
    • OBESITY
    • SKELETAL DEFORMITY (KYPHOSIS, STERNUM)
    • SPINAL CORD TRANSECTION
  28. THIS FORM OF EXTRINSIC PULMONARY DISEASE CAN FIND ITS ORIGIN AS AN AUTOIMMUNE DISEASE AND CAUSES AN ASCENDING PARALYSIS REQUIRING MECHANICAL VENTILATION FOR SEVERAL MONTHS?
    GUILLAIN BARRE SYNDROME
  29. WHAT MEDICATIONS SHOULD BE AVOIDED WITH MUSCULAR DYSTROPHY AND WHY?
    CNS DEPRESSANTS BECAUSE THEY MAY EXACERBATE PRE-EXISTING PULMONARY DYSFUNCTION
  30. LIST 4 NON-SPECIFIC SYMPTOMS ASSOCIATED WITH A PULMONARY EMBOLISM.
    • TACHYCARDIA
    • HEMOPTYSIS
    • FEVER
    • HOMAN'S SIGN (CALF PAIN)
  31. LIST 4 COMMON ECG CHANGES SEEN WITH PULMONARY EMBOLISM
    • ST-T WAVE CHANGES
    • RIGHT AXIS DEVIATION
    • RBBB
    • PEAKED P WAVES
  32. HOW CAN A PULMONARY EMBOLISM BE DIAGNOSED CLINICALLY?
    • HYPOXIA
    • REDUCED END TIDAL CO2
    • TACHYCARDIA
    • HYPOTENSION
  33. WHAT IS THE TREATMENT FOR PULMONARY EMBOLISM.
    • OXYGEN 100%
    • ACLS
    • HEPARIN BOLUS AND INFUSION
    • CV SUPPORT (FLUIDS AND/OR PRESSORS)

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