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Worksheetsanesthesia for respiratory disease
Total questions: 40
Worksheet time: 22mins
Which of the following is not a characteristic feature of asthma?
Chronic inflammatory changes in the submucosa of the airways
Airway hyper responsiveness
Reversible expiratory airflow obstruction
Elastase deficiency in the airways
A 55-year-old male presented to you with a pulmonary function test report, which shows an increase in FEV1 of greater than 0.2 L (more than 12%) in response to bronchodilators. Which characteristic of his respiratory illness is depicted here?
Bronchial asthma—acute bronchodilator responsiveness
Chronic obstructive pulmonary disease (COPD)—variability in airflow obstruction
COPD—acute bronchodilator responsiveness
Mild to moderate restrictive lung disease
Which of the following techniques is associated with a lower complication rate related to bronchospasm in the asthmatic population?
Regional anesthesia
General anesthesia—laryngeal mask airway (LMA)
General anesthesia—endotracheal tube (ETT)
Combined general and neuraxial anesthesia
A 22-year-old patient with a history of moderate persistent asthma on medium-dose inhaled corticosteroids and long-acting inhaled β-agonist
presents for an emergency appendectomy. On clinical examination, he is actively wheezing, but maintaining an oxygen saturation of 99% on room air. Which of the following statements about this clinical scenario is most appropriate?
Presence of wheezing on physical examination indicates that he is having a severe attack of asthma
Volatile anesthetics cause bronchodilation through catecholamine independent mechanisms
Increased airway resistance that occurs intraoperatively is usually due to acute exacerbation of asthma
A laryngeal mask airway (LMA) is more stimulating to the airway than an endotracheal tube, and should be avoided in asthmatics
At the end of laparotomy for actively asthmatic patient (with preoperative wheezes), the surgeon requests you to extubate the patient fully awake because he found extensive intestinal adhesions and is afraid of retained gastric contents in the stomach. Which of the following will be your most likely plan of action?
Insert an orogastric tube, empty the stomach as much as you can, and proceed with a deep extubation to avoid bronchospasm
Administer intravenous lidocaine to decrease the likelihood of airway stimulation and wait till the patient is fully awake before extubation
Shut off the inhalational agent and use intravenous propofol to avoid transitioning through a rocky stage-2 wake up
Transition to a laryngeal mask airway (LMA) under sevoflurane anesthesia and let the patient wake up with an LMA
Which of the following is true regarding administering general anesthesia to a chronic obstructive pulmonary disease (COPD) patient?
Nitrous oxide + opioid technique is ideal
Use large tidal volumes
Use lower breathing rates to permit more exhalation time
Correct the hypercapnia intraoperatively to help extubate early
Which of the following is not a part of the “STOP BANG” screening questionnaire for obstructive sleep apnea (OSA)?
Snoring
Observed apnea
Exercise tolerance
High blood pressure
A 55-year-old patient with a history of asthma and heart failure is to undergo a hernia repair. On physical examination, you notice that the patient is wheezing. Following treatment with albuterol, the patient should be monitored for which electrolyte?
Potassium
Calcium
Sodium
Chloride
A 75-year-old patient with coronary artery disease, hypertension, and chronic obstructive pulmonary disease (COPD) is undergoing a left colectomy for cancer. He had a COPD exacerbation 4 months ago and was on steroids for a week at the time. Steroid replacement
Should be given at a dose greater than 10 times the normal daily cortisol production rate
Should not exceed 100 to 150 mg of cortisol equivalent per day
Is not necessary in this patient
Should include 100 mg of cortisol, tapered over 5 to 7 days
Restrictive pulmonary diseases are best characterized by which physiological pattern?
Increased FEV1/FVC with obstruction
Elevated volumes with high resistance
Normal compliance with low expiratory flow
Decreased compliance and reduced volumes
In early obstructive disease, which parameter is often the only abnormality detected?
Forced expiratory flow 25–75% reduction
Peak inspiratory pressure elevation
Total lung capacity reduction
Residual volume reduction
As obstructive disease progresses, what typical pattern appears in spirometry?
Increased FEV1 and increased FEV1/FVC
Normal FEV1 with decreased TLC
Increased FEV1 with increased diffusion capacity
Decreased FEV1 and decreased FEV1/FVC
Which statement best characterizes ipratropium’s role in asthma management?
Direct phosphodiesterase inhibitor with narrow range
Powerful mast cell stabilizer preventing degranulation
Potent β1-selective bronchodilator for rescue
Moderate antimuscarinic bronchodilator via inhalation
Which clinical sign most strongly suggests impending respiratory failure in an acute asthma attack?
Presence of pulsus paradoxus
Increased TLC and RV on spirometry
Low PaCO2 due to hyperventilation
Normal or high PaCO2 indicating fatigue
In treating severe acute asthma in the emergency setting, what is the most evidence-supported initial pharmacologic strategy?
Start intravenous magnesium sulfate alone
Give high-dose oral prednisone immediately
Administer inhaled β2-agonist via nebulizer
Begin leukotriene modifiers for rapid relief
During inhalation induction, which agents more commonly provoke cough, laryngospasm, and bronchospasm?
Isoflurane and desflurane
Sevoflurane and halothane
Enflurane and sevoflurane
Nitrous oxide and xenon
What capnography change suggests airflow obstruction ?
High end-tidal CO2 without slope change
Sudden drop of end-tidal CO2
Delayed-expiration rise of end-tidal CO2 value
Early-expiration rise of end-tidal CO2 value
Which ventilatory approach helps avoid air trapping in severe asthma?
Low tidal volumes with prolonged expiratory time
High tidal volumes with short expiratory time
High respiratory rate with long inspiratory time
Zero PEEP with large tidal volumes
Which drugs are best avoided due to histamine release precipitating bronchospasm?
Fentanyl, rocuronium, ketamine release histamine
Succinylcholine, dexmedetomidine release histamine
Atracurium, morphine, meperidine release histamine
Midazolam, propofol, glycopyrrolate release histamine
What is the initial management priority for intraoperative bronchospasm?
Switch to total intravenous anesthesia
Increase opioid dosing significantly
Decrease volatile anesthetic concentration immediately
Administer aerosolized bronchodilator promptly
Which criterion best defines the clinical diagnosis of chronic bronchitis?
Productive cough on most days for 3 months each year for 2 years
Productive cough present intermittently for 1 year
Dry cough with wheeze for 6 months in a single year
Productive cough only during respiratory infections
Which finding most commonly differentiates emphysema from chronic bronchitis on chest radiograph?
Lobar consolidation with air bronchograms
Cardiomegaly with pulmonary venous congestion
Diffuse interstitial infiltrates throughout both lungs
Hyperinflation with flattened diaphragms
Why might nitrous oxide be avoided in COPD patients ?
It eliminates beneficial hypoxic vasoconstriction
It causes bronchodilation only
It may enlarge bullae and raise pulmonary pressures
It raises dead space ventilation via 2nd gas effect
In restrictive disease, how are FEV1 and FVC typically affected?
FEV1 reduced, FVC normal, low ratio
Both increased, with elevated FEV1/FVC ratio
FEV1 normal, FVC reduced, high ratio
Both reduced, with normal FEV1/FVC ratio
During intraoperative care of ARDS, which ventilation strategy is appropriate?
Low tidal volume 4–6 mL/kg with higher rate
High tidal volume 10–12 mL/kg with low rate
Peak airway pressures above 40 cm H2O routinely
Zero PEEP with permissive hypoxia policy
What end‑tidal CO2 consideration is typical with low tidal volume ventilation in ARDS?
Increase in end‑tidal CO2 due to permissive hypercapnia
Decrease in end‑tidal CO2 due to hyperventilation (rapid respiratory rate)
No change in end‑tidal CO2 due to normal minute ventilation
Immediate normalization of PaCO2 with high PEEP
Which preoperative metric indicates severe dysfunction in chronic interstitial lung disease (ILD)?
FEV1 greater than 70% predicted
Vital capacity less than 15 mL/kg
DLCO higher than normal limits
Arterial oxygen saturation above 94%
Which arterial blood gas pattern most commonly appears in acute pulmonary embolism in a spontanousely breathing patient?
Mild hypoxemia with metabolic acidosis
Mild hypoxemia with respiratory alkalosis
Severe hypercapnia with normal oxygenation
Normal gases without hypoxemia
Which echocardiographic sign supports the diagnosis of massive pulmonary embolism perioperatively?
Left atrial enlargement without dysfunction
Normal right heart with septal thickening
Right ventricular overload with tricuspid regurgitation
Left ventricular dilation with high preload
Which intraoperative change most specifically suggests pulmonary embolism?
Stable end-tidal CO2 with tachycardia and/or arrhythmias
Decrease in end-tidal CO2 concentration
Increase in end-tidal CO2 concentration
Increase in peak airway pressure without hypoxemia
In pulmonary hypertension secondary to chronic thromboembolism, which perioperative therapy can lower pulmonary pressures?
Epinephrine infusion for all cases
High-dose beta-blockers routinely
High sevoflurane and nitrous oxide
Inhaled nitric oxide or prostacyclin
When venous air is identified in the right atrium intraoperatively, which immediate action can be lifesaving?
Administering aerosolized bronchodilator therapy
Switching to pressure‑support ventilation
Lowering FIo2 by addind nitrous oxide
Emergency central venous cannulation with aspiration
A 65-year-old woman with severe COPD is undergoing a laparoscopic hysterectomy under general anesthesia. Her end tidal CO2 is 65mmHg. After increasing her RR from 20 to 30 breaths per minute, you notice she is becoming hypotensive. Which of the following actions is MOST appropriate in her initial management?
Bolus 1mg epinephrine IV
Bolus 2L IV fluid
Disconnect the patient from the ventilator briefly
Inform the surgeon that you need to cancel the case
Which of the following helps distinguish obstructive from restrictive lung disease?
Total lung capacity is reduced in both, but more in obstructive disease.
FEV1/FVC is reduced in obstructive disease, but unchanged or increased in restrictive.
FEV1/FVC is increased in obstructive disease, but unchanged or decreased in restrictive.
DLCO is normal in obstructive disease, but reduced in restrictive.
Reduced lung volumes with reduced Diffusing Capacity for Carbon Monoxide (DLCO) suggests what kind of disease?
Restrictive disease due to interstitial lung disease
Restrictive disease due to extra-pulmonary cause
Obstructive disease due to COPD
Obstructive disease due to asthma
What is the most common cause of death, other than disease progression, in pulmonary fibrosis?
Renal failure
Right heart failure
Hypercarbic respiratory failure
End stage liver fibrosis
Which of the following is more common in restrictive lung disease than obstructive lung disease?
Hypercapnia
Hypoxemia
Auto-Peep
Increased residual volume
A patient with restrictive lung disease, due to scoliosis, would be most likely to have which set of findings for lung volumes and Diffusing Capacity Carbon Monoxide (DLCO)?
Normal lung volumes with reduced DLCO
Reduced lung volumes with reduced DLCO
Normal lung volumes with normal DLCO
Reduced lung volumes with normal DLCO
A 22-year-old woman with no significant medical history is undergoing laparoscopic appendectomy under general anesthesia. While placing the patient into Trendelenburg position, the SpO2 decreases from 100% to 92%. Which of the following is the MOST likely cause?
Decrease in functional residual capacity
Decrease in total lung capacity
Decrease in closing capacity
Extensive CO2 absorbtion
An 80-year-old woman with no significant past medical history is scheduled to undergo a cystoscopy due to nephrolithiasis. Preoperatively, she is noted to have an SpO2 of 94% on room air. Which of the following is the MOST likely cause of the decrease in baseline SpO2?
Decreased functional residual capacity
Increased closing capacity
Decreased compliance of small airways
Respiratory muscles weakness with aging
