Asthma and COPD Q 19 - Gyan Darpan : Learning Portal
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Sunday 24 April 2022

Asthma and COPD Q 19

Which of the following respiratory disorders is most common in the first 24 to 48 hours after surgery?
     A. Atelectasis
     B. Bronchitis
     C. Pneumonia
     D. Pneumothorax

Correct Answer: A. Atelectasis

Atelectasis develops when there’s interference with the normal negative pressure that promotes lung expansion. Clients in the postoperative phase often splint their breathing because of pain and positioning, which causes hypoxia. Postoperative atelectasis typically occurs within 72 hours of general anesthesia and is a well-known postoperative complication. The decrease in pressure allows for passive movement of air into the lungs. This process is inhibited by general anesthesia due to diaphragm relaxation. Patients lying supine have cephalad displacement of the diaphragm further decreasing the transmural pressure gradient and increasing the likelihood of atelectasis. It’s uncommon for any of the other respiratory disorders to develop.

Option B: Acute bronchitis is caused by infection of the large airways commonly due to viruses and is usually self-limiting. Bacterial infection is uncommon. Approximately 95% of acute bronchitis in healthy adults is secondary to viruses. It can sometimes be caused by allergens, irritants, and bacteria. Irritants include smoke inhalation, polluted air inhalation, dust, among others.
Option C: While identifying an etiologic agent for pneumonia is essential for effective treatment as well as epidemiological record keeping, this is seldom seen in clinical practice. Widespread reviews have shown that a single cause of pneumonia has often been identified in less than 10% of patients presenting to the emergency department.
Option D: A pneumothorax is defined as a collection of air outside the lung but within the pleural cavity. It occurs when air accumulates between the parietal and visceral pleura inside the chest. The air accumulation can apply pressure on the lung and make it collapse. The degree of collapse determines the clinical presentation of pneumothorax. Air can enter the pleural space by two mechanisms, either by trauma causing a communication through the chest wall or from the lung by rupture of visceral pleura.

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