Senior Seminar Respiratory Review

Multiple Choice

All of the intrinsic laryngeal muscles are innervated by the Recurrent Laryngeal Nerve (RLN) EXCEPT the:

• Vocalis

• Thyroarytenoid

• Cricothyroid

• Posterior cricoarytenoid

Multiple Choice

The cricothyroid muscle receives motor innervation from which branch of the superior laryngeal nerve (SLN)?

• Internal

• External

• Extrinsic

• Intrinsic

Multiple Choice

_____ laryngeal muscles control the tension & position of the vocal cords, whereas _____ laryngeal muscles support the larynx inside the neck and assist with swallowing

• Intrinsic, External

• Extrinsic, Intrinsic

• External, Internal

• Intrinsic, Extrinsic

Multiple Choice

The glossopharyngeal nerve (CN 9) provides sensory innervation from the oropharynx down to the:

• Base of the tongue

• Anterior side of the epiglottis

• Vocal cords

• Posterior side of the epiglottis

Multiple Choice

Acute injury to which laryngeal nerve(s) results in respiratory distress requiring immediate securement of the airway?

• Right Recurrent Laryngeal Nerve (RLN)

• Left Recurrent Laryngeal Nerve (RLN)

• Superior Laryngeal Nerve (SLN)

• Bilateral Recurrent Laryngeal Nerves (RLN)

Multiple Select

Contraindications to using cocaine-soaked pledgets in the nares include: [select 3]

• PChE deficiency

• SSRI use

• MAOI use

• Increased SNS tone

• Lidocaine allergy

Multiple Choice

The adult larynx lies anterior to:

• C3-C6

• C4-C7

• C2-C5

• C6-T1

Multiple Choice

In children under 5 years old, the narrowest FIXED region of the larynx is considered to be the:

• Vocal cords

• Cricoid ring

• Proximal trachea

• Distal trachea

Multiple Select

Select 3 risk factors that predispose patients to laryngospasm:

• Active/recent URI

• Age > 1 year

• GERD

• Deep anesthesia

• Hypocapnia

Multiple Choice

Relaxation of the _____ muscle results in tongue obstruction, whereas relaxation of the _____ muscle results in soft palate obstruction

• Tensor palatine, genioglossus

• Genioglossus, tensor palatine

• Cricothyroid, omohyoid

• Genioglossus, cricothyroid

Multiple Choice

During inspiration, the diaphragm & external intercostal muscles contract, resulting in decreased thoracic pressure and increased thoracic volume. Whose law dictates this process?

• Charles

• Boyle

• Gay-Lussac

• Laplace

Multiple Choice

In regards to divisions of the airway, the transitional zone begins with the respiratory bronchioles. These correspond with what generation in the airway?

• 15

• 16

• 17

• 23

Multiple Choice

True or False: During normal tidal breathing, transpulmonary pressure (TPP) is always positive and intrapleural pressure is always negative

• True

• False

Multiple Choice

Assuming Vd is 2 mL/kg, calculate the alveolar ventilation (VA) for a 75-kg male breathing 16 times per minute with a tidal volume of 525 mL.

• 6,000 mL/min

• 8,400 mL/min

• 6,500 mL/min

• 8,000 mL/min

Multiple Select

The following factors will cause a decrease in dead space (Vd): [select 3]

• Endotracheal intubation

• Anticholinergic administration

• Neck extension

• Neck flexion

• Trendelenburg position

Multiple Choice

True or False: alveoli in non-dependent regions of the lung exhibit the greatest degree of compliance and ventilation

• True

• False

Multiple Choice

What is the most common cause of hypoxemia in the PACU?

• Apnea

• Residual neuromuscular blockade

• Atelectasis

• Negative-pressure pulmonary edema

Multiple Choice

True or False: all alveoli have the same CONCENTRATION of surfactant

• True

• False

Multiple Choice

Which West Lung Zone corresponds with the following:

Pa > Pv > PA

• Zone 1 (Dead Space)

• Zone 2 (Waterfall)

• Zone 3 (Shunt)

• Zone 4 (Pulmonary Edema)

Multiple Choice

Which cause of hypoxemia CANNOT be corrected with supplemental oxygen?

• Hypoventilation (obesity, pregnancy)

• Diffusion impairment (pulmonary fibrosis, emphysema)

• V/Q mismatch (OLV, PE)

• Large shunt (atelectasis, PNA)

Multiple Select

Which of the following factors will increase residual volume (RV), closing capacity (CC), and total lung capacity (TLC)? [select 3]

• Asthma

• Emphysema

• Pregnancy

• Obesity

• Bronchitis

Multiple Choice

Assuming perfect preoxygenation/denitrogenation, calculate the time until desaturation in a patient with an FRC of 2,300 mL and a VO2 of 250 mL/min.

• 8.1 minutes

• 9.2 minutes

• 7.6 minutes

• 6.3 minutes

Multiple Choice

By what age does Closing Capacity (CC) correspond with Functional Residual Capacity (FRC) when awake and supine?

• 33

• 44

• 55

• 66

Multiple Select

Which processes yield 2 ATP molecules? [select 3]

• Glycolysis

• Krebs cycle/citric acid cycle

• Oxidative phosphorylation

• Lactic acid pathway (anaerobic metabolism)

Multiple Choice

The Hamburger shift involves which ion moving intracellularly to maintain electrical neutrality?

• Sodium (Na⁺)

• Chloride (Cl⁻)

• Calcium (Ca²⁺)

• Carbonic anhydrase

Multiple Choice

A patient with no comorbidities at baseline presents with ARDS. Her first ABG reveals a PaCO2 of 40 mmHg and pH 7.32. A few hours later, a repeat ABG shows a PaCO2 of 60 mmHg. What pH do you anticipate seeing?

• 7.24

• 7.29

• 7.16

• 7.26

Multiple Select

Name 2 factors that decrease the slope of the CO₂ ventilatory response curve:

• Light anesthesia

• Deep anesthesia

• CNS stimulants

• Opioids

• Metabolic acidosis

Multiple Choice

Which part of the respiratory center is referred to as the respiratory pacemaker?

• Cerebral cortex

• Pneumotaxic center

• Dorsal respiratory group

• Central chemoreceptors

Multiple Choice

What is the primary stimulus at the central chemoreceptor?

• PaO2

• H+

• HCO3-

• N2O

• H2CO3

Multiple Choice

All of the statements regarding peripheral chemoreceptors are true EXCEPT:

• The carotid body monitors for PaO2 levels < 60 mmHg

• Peripheral chemoreceptors are primarily made up of glomus cells

• Peripheral chemoreceptors respond to PaO2 levels in the CSF

• CEA severs the afferent limb of the hypoxic ventilatory response

Multiple Choice

Which statement is true regarding hypoxic pulmonary vasoconstriction (HPV)?

• A response that stops further inspiration when lung inflation is > 1.5 L above FRC

• A physiological, protective response to hypoxia where the pulmonary vascular bed vasoconstricts to minimize shunt flow during atelectasis

• An increase in minute ventilation in response to PaO2 levels < 60 mmHg

• A protective reflex that involves closure of the glottic opening to prevent pulmonary aspiration

Multiple Select

Hypoxic pulmonary vasoconstriction (HPV) is inhibited by: [select 3]

• Dopamine

• Ondansetron

• Nitro-glycerin

• Milrinone

• PEEP 5 cmH2O

Multiple Choice

True or False: Substance P and Neurokinin A are chemical mediators released by non-cholinergic C-fibers which promote bronchodilation

• True

• False

Multiple Choice

What nerve innervates the smooth muscle airways?

• Vagus nerve

• Phrenic nerve

• Suprascapular nerve

• Glosso-pharyngeal nerve

Multiple Choice

Side effects of beta-2 agonists include all EXCEPT:

• Tachycardia

• Hypokalemia

• Sedation

• Hyperglycemia

• Dysrhythmais

Multiple Choice

Normal FEV-1 is greater than ____ of the predicted value

• 50%

• 80%

• 90%

• 40%

Multiple Choice

Spirometry testing that is the MOST sensitive indicator of small airway disease:

• FEV-1

• DLCO

• MMEF

• FEV-1/FVC ratio

Multiple Choice

To effectively reduce PPCs, the patient must refrain from smoking for at least

• 2 weeks

• 4 months

• 6 weeks

• 10 weeks

Multiple Choice

Which dynamic values would be expected in patients with restrictive lung disease but not obstructive lung disease?

• Decreased FEV-1

• Decreased FEF 25-75%

• Normal FEV-1/FVC ratio

• Increased FVC

Multiple Choice

Choose the waveform associated with this flow-volume loop:

• Obstructive disease

• Fixed lesion

• Restrictive disease

• Asthma

Multiple Select

A patient presents to the ED having a severe asthma episode. Expected findings on an ABG include: [select 2]

• Respiratory acidosis

• Hypercarbia

• Hypocarbia

• Respiratory alkalosis

Multiple Select

Contributing factors to COPD include: [select 2]

• Alcohol use

• Cigarette smoking

• Working 25 years in a textile mill

• Obesity

• Pregnancy

Multiple Choice

Right-sided heart failure that occurs due to pulmonary HTN from elevated pulmonary vascular resistance (and can be seen with conditions such as COPD) is referred to as:

• Cor pulmonale

• Eisenmenger syndrome

• Vena cava syndrome

• Wolff-Parkinson-White syndrome

Multiple Select

Anesthetic considerations for mechanical ventilation in a patient with COPD include: [select 2]

• Tidal volumes 6-8 mL/kg of IBW

• Tidal volumes 10-12 mL/kg of IBW

• Increasing I:E ratio to 1:1

• Decreasing I:E ratio to 1:2 to 1:3

Multiple Choice

Consequences of dynamic hyperinflation on the cardiopulmonary system include all of the following EXCEPT:

• Barotrauma

• Hypertension

• Pneumothorax

• Decreased venous return

• Elevated PIP

Multiple Select

All of the following are examples of restrictive lung disease EXCEPT: [select 2]

• Sarcoidosis

• Asthma

• Pulmonary embolism

• Pneumothorax

• Obesity

Multiple Select

Major risk factors for aspiration pneumonitis: [select 3]

• GI obstruction

• Emergency surgery

• Age < 8 years

• Trauma

• History of migraines

Multiple Select

Clinical presentation of pneumothorax includes: [select 3]

• Hypotension

• Elevated airway pressures

• Bradycardia

• Hypoxemia

• Altered mental status

Multiple Choice

The definitive treatment for a pneumothorax is:

• Thoracotomy

• Thoracentesis

• Bronchoscopy

• Chest tube insertion

Multiple Choice

The most sensitive diagnostic tool for VAE is:

• NIBP monitoring

• Precordial Doppler

• TEE

• Pulse oximetry

• ETCO2 monitoring

Multiple Choice

Pulmonary hypertension is diagnosed when mean pulmonary artery pressures exceed:

• 25 mmHg

• 10 mmHg

• 15 mmHg

• 5 mmHg

Multiple Choice

An inhaled agent that can decrease pulmonary vascular resistance, which then reduces RV workload, is known as:

• Nitrous oxide (N2O)

• Nitric oxide (NO)

• Desflurane

• Suprane

Multiple Select

Strong indications for mechanical ventilation include: [select 2]

• PaCO2 52 mmHg

• Vital capacity 10 mL/kg

• PaO2 108 mmHg on 100% FiO2

• Noncompliance with BiPAP

Multiple Choice

Medications that can be administered through the ETT include all except for:

• Norepinephrine

• Atropine

• Lidocaine

• Vasopressin

Multiple Select

Absolute indications for one-lung ventilation (OLV) include: [select 2]

• Massive hemorrhage

• Severe hypoxemia

• Bronchopleural fistula

• Esophageal resection

Multiple Choice

An ideal DLT size for a 165 cm, 41-year-old female undergoing a right pneumonectomy would be:

• 37 Fr

• 41 Fr

• 28 Fr

• 32 Fr

Multiple Select

Unlike a double-lumen endotracheal tube, the bronchial blocker CANNOT: [select 3]

• Insufflate O₂ into the isolated lung

• Ventilated the isolated lung

• Provide lung separation in the patient requiring nasotracheal intubation

• Prevent contamination from contralateral lung infection

• Suction secretions from the isolated lung

Multiple Select

Identify the MOST COMMON serious complications of mediastinoscopy: [select 2]

• Chylothorax

• Pneumothorax

• Left RLN injury

• Hemorrhage

Multiple Select

Identify the MOST important strategies for managing mechanical ventilation in the patient with ARDS: [select 2]

• Low tidal volume

• Reducing plateau pressure

• High-frequency oscillatory ventilation

• Permissive hypocapnia

Multiple Choice

View the exhibit. Which letter correctly identifies a tonsillar pillar?

• A

• B

• C

• D

Multiple Choice

True or False: By itself, Mallampati classification is an excellent predictor of a difficult airway

• True

• False

Multiple Choice

View the exhibit. What is this patient's Mandibular Protrusion Test score?

• Class I

• Class II

• Class III

• Class IV

Multiple Choice

Atlanto-occipital joint extension less than ___ degrees is associated with difficult laryngoscopy

• 23

• 25

• 30

• 32

Multiple Choice

A gum elastic bougie (Eschmann stylet) is BEST applied with what Cormack & Lehane grades?

• I & IIa

• IIa & III

• IIb & III

• III & IV

Multiple Choice

Upon engaging the vallecula, the CRNA visualizes the posterior laryngeal cartilages and a portion of the glottic opening. This corresponds with what Cormack & Lehane grading?

• Grade I

• Grade II

• Grade III

• Grade IV

Multiple Select

Identify the BEST predictors of difficult mask ventilation [select 3]

• Mallampati Class IV

• Old Age

• Edentulousness

• Restricted mouth opening

• Presence of a beard

Multiple Choice

Which of the following scenarios would warrant a rapid-sequence induction (RSI)?

• Trauma presenting for emergent reconstructive surgery

• Symptomatic GERD

• C-section complicated by failed neuraxial anesthesia

• All of these

Multiple Select

Which congenital conditions are associated with an underdeveloped mandible? [select 2]

• Treacher-Collins

• Klippel-Feil

• Goldenhar

• Pierre-Robin

Multiple Choice

What is the optimal positioning for tracheal intubation?

• Cervical flexion only

• Atlanto-occipital joint extension only

• Cervical flexion & atlanto-occipital joint extension

• Cervical extension & Atlanto-occipital joint flexion

Multiple Select

Contraindications that would preclude the use of a nasopharyngeal airway (NPA) include: [select 2]

• Dental trauma

• Uncorrected coagulopathy

• Pierre-Robin Sequence

• LeFort II Fracture

Multiple Choice

When considering direct laryngoscopy (DL) blades, all of the following are true EXCEPT:

• The Macintosh blade indirectly lifts the epiglottis

• The Miller blade directly lifts the epiglottis

• The Macintosh blade is a straight-blade design

• The Miller blade is a straight-blade design

Multiple Choice

Tracheal ischemia can occur if ETT cuff pressure exceeds ___ cmH2O

• 20

• 25

• 30

• 40

Multiple Choice

True or False: Nearly all ETTs in modern practice utilize high-volume, low-pressure cuffs

• True

• False

Multiple Choice

What is an appropriate UNCUFFED ETT size for a 4-year-old male?

• 4.0

• 5.0

• 6.0

• 7.0

Multiple Choice

A 22-year-old male with Down syndrome is presenting for a robotic-assisted laparoscopic appendectomy. What should be the CRNA's first choice for airway management?

• Direct laryngoscopy with a Macintosh 3 blade

• Direct laryngoscopy with a Miller 2 blade

• RSI with any blade

• Video laryngoscopy with an appropriately-sized GlideScope blade

Multiple Choice

The GlideScope blade has what degree of anterior bend?

• 40

• 60

• 80

• 100

Multiple Choice

What is an appropriate size LMA for a 65 kg, 39-year-old female?

• 3

• 4

• 5

• 6

Multiple Select

What are the anatomical borders for proper LMA seating? [select 3]

• Vallecula

• Base of the tongue

• Piriform sinus

• Upper esophageal sphincter

Multiple Choice

All of the following are techniques to reduce the risk of aspiration with LMAs EXCEPT:

• Removing the LMA at the first sign of rejection during emergence

• Using the correct device size

• Maintaining a deep enough plane of anesthesia to prevent swallowing

• Inflating the cuff to greater than 20 cmH2O

Multiple Select

Contraindications that preclude the use of a Combitube include: [select 3]

• Full stomach

• Morbid obesity

• Zenker's Diverticulum

• Intact gag reflex

• Prolonged use

Multiple Choice

Identify the STRONGEST contraindication to awake fiberoptic intubation

• Coagulopathy

• Perilaryngeal mass

• Blood in the airway

• Lack of provider skill

Multiple Choice

View the exhibit. Select the laryngoscopic view where the Eschmann Stylet (gum elastic bougie) provides the MOST SIGNIFICANT benefit

• A

• B

• C

• D

Multiple Select

Choose the MOST appropriate indications for retrograde intubation [select 2]

• Tracheal stenosis

• Can't Ventilate, Can't Intubate scenario

• Unstable cervical spine

• Upper airway bleeding

Multiple Choice

All of the following are contraindications for tracheostomy placement EXCEPT:

• History of neck radiation

• BMI > 40 kg/m2

• Age < 6

• There are no absolute contraindications for tracheostomy

Multiple Choice

Following the induction of general anesthesia, initial intubation attempts are unsuccessful and mask ventilation is not adequate. According to the ASA difficult airway algorithm, what is the NEXT immediate step?

• Wake the patient up

• Place a supraglottic airway device

• Call for help

• Perform a percutaneous cricothyrotomy

Multiple Select

Deep extubation provides the MOST SIGNIFICANT benefit in the patient with: [select 2]

• Asthma

• Obstructive sleep apnea (OSA)

• Parkinson's Disease

• Coronary Artery Disease

Multiple Choice

What is the BEST technique to manage the patient at high risk of failed extubation?

• Eschmann Stylet (gum elastic bougie)

• Airway Exchange Catheter (AEC)

• Nasal airway

• Supraglottic airway device