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MI Clinical Manifestations and Assessment of Respiratory Disease > Ch 23,24,25,29,30 > Flashcards

Ch 23,24,25,29,30 Flashcards

Exam

1
Q

Which of the following are anatomic alterations that occur when a person has a pneumothorax?

  1. The lung on the affected side collapses.
  2. The visceral and parietal pleura separate.
  3. The visceral pleura adheres to the parietal pleura.
  4. The chest wall moves outward.
A

1, 2, 4

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2
Q

A pneumothorax manifests itself clinically as a primary _____ disorder

A

restrictive

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3
Q

What is the primary cause of hypotension in a patient with a large pneumothorax?

A

Decreased venous return to the heart

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4
Q

According to the way gas enters the pleural space, a pneumothorax will be classified as:

  1. intrinsic.
  2. extrinsic.
  3. open.
  4. closed.
A
  1. open.

4. closed.

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5
Q

A patient had a penetrating knife wound to her chest wall that resulted in a valvular pneumothorax. What is another term for this condition?

A

Tension pneumothorax

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6
Q

A 17-year-old male has been brought to the hospital because he felt short of breath after being tackled in a football game. A chest radiograph shows a broken rib and a 20% pneumothorax in the right lung. Which of the following conditions would be present?

A

Closed pneumothorax

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7
Q

A 6-foot-tall, 140-pound, 28-year-old female patient has come to the emergency department with a complaint of a sudden sharp pain in the right upper chest followed by shortness of breath. The pain originated while she participated in deep breathing exercises in a yoga class. The physician has determined that she has a 15% pneumothorax. How should the pneumothorax be classified?

A

Spontaneous

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8
Q

An iatrogenic pneumothorax may be caused by all of the following EXCEPT:

a. positive-pressure mechanical ventilation.
b. pleural biopsy.
c. subclavian vein cannulation.
d. endotracheal intubation.

A

endotracheal intubation

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9
Q

A 40-year-old patient requires placement of a thoracostomy chest tube. All of the following are recommended for the procedure EXCEPT:

a. application of –5-cm H2O pressure to the chest tube.
b. use of a No. 28 to 36 French gauge tube.
c. placement of the tube at the apex of the lung.
d. clamping and removing the tube within 24 hours of insertion.

A

clamping and removing the tube within 24 hours of insertion.

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10
Q

After a patient experienced four pneumothoraces of her right lung over a 24-month period, the physician recommended a procedure to reduce the occurrence of future pneumothoraces. Which procedure would the physician have recommended?

A

Pleurodesis

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11
Q

A patient has a pneumothorax with a sucking chest wound resulting in the movement of gas from one lung to another. This is called:

A

pendelluft

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12
Q

Which of the following chest assessment findings would be expected in a patient with a tension pneumothorax?

a. Decreased thoracic volume on the affected side
b. Dull percussion note
c. Tracheal shift away from the affected side
d. Wheezes

A

Tracheal shift away from the affected side

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13
Q

Which of the following hemodynamic indices will be found in a patient with a large hemothorax?

A

Decreased CO

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14
Q

If the patient has a tension pneumothorax, all of the following chest radiograph findings would be expected EXCEPT:

a. elevated diaphragm.
b. mediastinal shift to the unaffected side.
c. increased translucency on the side of the pneumothorax.
d. atelectasis.

A

elevated diaphragm.

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15
Q

A sucking chest wound would be classified as a(n) _____ pneumothorax

A

open

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16
Q

Which type of pneumothorax would result from the rupture of bulla on the surface of a lung?

A

Spontaneous pneumothorax

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17
Q

Which type of untreated pneumothorax is considered to be the most serious?

A

Tension

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18
Q

The anatomic alteration caused by a pleural effusion is:

A

separation of the visceral and parietal pleura.

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19
Q

The major pathologic and structural changes associated with a significant pleural effusion include all of the following EXCEPT:

a. diaphragm elevation.
b. atelectasis.
c. compression of the great vessels.
d. lung compression.

A

a. diaphragm elevation.

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20
Q

Which of the following are associated with a transudative pleural effusion?

  1. Thin and watery fluid
  2. Fluid has a lot of cellular debris
  3. Fluid has high protein count
  4. Few blood cells
A

1, 4

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21
Q

A patient has malignant mesothelioma related to chronic asbestos exposure. What would his pleural effusion fluid likely show on laboratory analysis?

  1. Erythrocytes
  2. Lymphocytes
  3. Normal mesothelial cells
  4. Malignant mesothelial cells
A

2, 3, 4

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22
Q

An adult patient with a large pleural effusion requires placement of a thoracostomy tube. Which of the following statements are true regarding thoracostomy tube placement?

  1. The tube is placed in the 2nd to 3rd intercostal space.
  2. The tube is placed in the 4th to 5th intercostal space.
  3. The tube is placed in the midclavicular line.
  4. The tube is placed in the midaxillary line.
A

2, 4

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23
Q

Treatment of an empyema usually includes:

A

thoracostomy tube insertion.

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24
Q

A patient has a pleural effusion from an unknown cause. A fluid sample has been taken for analysis. To help identify the cause of the effusion, all of the following tests should be performed EXCEPT:

a. specific gravity.
b. biochemical makeup.
c. cytologic examination.
d. bacterial culture.

A

specific gravity.

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25
Q

A respiratory therapist is assisting a physician who is performing a thoracentesis. It is suspected that the patient has a chylothorax. How would the pleural effusion be described

A

Milky white

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26
Q

During a chest assessment on a patient with a large pleural effusion, which of the following would be expected?

  1. Increased tactile and vocal fremitus
  2. Hyperresonant percussion note
  3. Diminished breath sounds
  4. Tracheal shift
A
  1. Diminished breath sounds

4. Tracheal shift

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27
Q

While reviewing an upright chest radiograph of a patient with a pleural effusion, the respiratory therapist observes a fluid density in the right lung area that extends upward around the anterior, lateral, and posterior thoracic walls. What is this characteristic sign called?

A

Meniscus sign

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28
Q

Which of the following are chest radiograph findings associated with a large pleural effusion?

  1. Blunting of the costophrenic angle
  2. Fluid level on the affected side
  3. Mediastinal shift toward the unaffected side
  4. Elevated hemidiaphragm on the affected side
A
  1. Blunting of the costophrenic angle
  2. Fluid level on the affected side
  3. Mediastinal shift toward the unaffected side
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29
Q

What percentage of patients with bacterial pneumonia are likely to develop pleural effusion?

A

Up to 40%

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30
Q

In the absence of surgery or trauma, what does the presence of blood in the pleural fluid most likely signify?

A

Malignant disease

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31
Q

What is the most common cause of a chylothorax?

A

Thoracic duct trauma

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32
Q

Posterior curvature of the spine best describes:

A

kyphosis.

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33
Q

Which of the following would be expected to appear on the chest radiograph of a patient with scoliosis?

a. Increased lung translucency
b. An S or C shape to the spine
c. Bullae
d. Pectus excavatum

A

An S or C shape to the spine

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34
Q

The major pathologic and structural changes of the lungs found with kyphoscoliosis include:

  1. mediastinal shift.
  2. elevated diaphragms.
  3. lung compression.
  4. mucus accumulation.
A

1, 3, 4

35
Q

Which age group is most likely to develop idiopathic scoliosis?

A

Adolescents

36
Q

Positive risk factor(s) for the development of kyphoscoliosis include:

  1. male gender.
  2. female gender.
  3. taller person.
  4. shorter person.
A
  1. female gender.

3. taller person

37
Q

Scoliosis is defined as a spinal curvature of _____ degrees.

A

> 10

38
Q

In which of the following is bracing the primary form of treatment?

a. Adolescents with idiopathic scoliosis (AIS)
b. Patients with congenital scoliosis
c. Patients with neuromuscular scoliosis
d. Infants with idiopathic scoliosis

A

Adolescents with idiopathic scoliosis (AIS)

39
Q

The Charleston bending brace is preferred over other braces because it:

A
  1. is worn for 8 to 10 hours at night.

3. is worn at night, when human growth hormone level is highest.

40
Q

A patient has a 45-degree curvature of her spine. The physician is most likely to recommend which of the following treatments?

a. Surgical intervention
b. Observation checkup in about 3 months
c. Milwaukee brace
d. Boston brace

A

Surgical intervention

41
Q

Which of the following chest assessment findings are associated with kyphoscoliosis?

  1. Crackles or wheezing
  2. Hyperresonant percussion note
  3. Whispered pectoriloquy
  4. Tracheal shift
A

1, 3, 4

42
Q

Which of the following pulmonary function results are likely to be found in a patient with kyphoscoliosis?

  1. Increased VT
  2. Normal or increased PEFR
  3. Decreased VC
  4. Decreased FVC
A
  1. Decreased VC

4. Decreased FVC

43
Q

A patient with severe kyphoscoliosis and chronic ventilatory failure with hypoxemia will have all of the following laboratory findings, EXCEPT:

a. increased PaCO2.
b. increased hematocrit.
c. normal pH.
d. increased pH.

A

increased pH.

44
Q

In a case of severe kyphoscoliosis, which of the following chest radiograph findings would be expected?

  1. Enlarged heart
  2. Areas of atelectasis
  3. Increased lung opacity
  4. Thoracic deformity
A
  1. Enlarged heart
  2. Areas of atelectasis
  3. Increased lung opacity
  4. Thoracic deformity
45
Q

What is the name for the degree of lateral spinal curvature calculated from a radiograph?

A

Cobb angle

46
Q

All of the following are orthotic braces used in the management of scoliosis EXCEPT _____ brace.

a. Boston
b. Milwaukee
c. Chicago
d. Charleston bending

A

Chicago

47
Q

For best results, how many hours per day should a SpineCor brace be worn?

A

20

48
Q

The peripheral nervous system problems found with Guillain-Barré syndrome (GBS) include:

  1. loss of reflexes.
  2. increased reflex reactions.
  3. flaccid paralysis of skeletal muscles.
  4. tetany of skeletal muscles
A

1, 3

49
Q

Under microscopic inspection, the skeletal muscle nerves of a Guillain-Barré patient show all of the following EXCEPT:

a. hypertrophy.
b. edema.
c. inflammation.
d. demyelination.

A

hypertrophy.

50
Q

The major pathologic or structural changes of the lungs associated with ventilator failure accompanying Guillain-Barré syndrome include:

  1. alveolar consolidation.
  2. airway distortion and dilation.
  3. mucosal edema.
  4. atelectasis.
A

1, 4

51
Q

In which of the following persons would Guillain-Barré syndrome most likely occur?

a. African-American female—22 years of age
b. Hispanic male—31 years of age
c. Asian female—17 years of age
d. Caucasian male—53 years of age

A

Caucasian male—53 years of age

52
Q

When a person has Guillain-Barré syndrome, how are peripheral nerves affected?

A

The myelin sheath is removed.

53
Q

Common noncardiopulmonary manifestations associated with Guillain-Barré is (are):

  1. difficulty swallowing.
  2. leg pain.
  3. distal paresthesia.
  4. absent deep tendon reflexes
A
  1. difficulty swallowing.
  2. leg pain.
  3. distal paresthesia.
  4. absent deep tendon reflexes.
54
Q

The diagnosis of Guillain-Barré syndrome is based on all of the following EXCEPT:

a. urinalysis shows elevated blood urea nitrogen.
b. abnormal electromyography results.
c. cerebrospinal fluid shows elevated protein level.
d. clinical history.

A

urinalysis shows elevated blood urea nitrogen.

55
Q

Clinical indications that a patient has impending acute ventilatory failure include:

  1. pH <7.35.
  2. vital capacity (VC) <20 mL/kg.
  3. PaCO2 >45 mm Hg.
  4. Negative inspiratory force (NIF) <25 cm H2O.
A
  1. pH <7.35.
  2. vital capacity (VC) <20 mL/kg.
  3. PaCO2 >45 mm Hg.
56
Q

A patient with Guillain-Barré is paralyzed and on mechanical ventilatory support. Which of the following pulmonary complications is most likely to occur as the result of prolonged immobilization?

A

Thromboembolism

57
Q

Which of following has been shown to shorten the course of a severe case of Guillain-Barré syndrome?

a. Renal dialysis
b. Plasmapheresis
c. Blood transfusion
d. NSAIDs

A

Plasmapheresis

58
Q

A 75-kg, 50-year-old male patient has Guillain-Barré syndrome. His most recent assessment indicates his VC is 900 mL and NIF is –16 cm H2O. What plan should the respiratory therapist recommend?

A

Initiate mechanical ventilation.

59
Q

Typical chest assessment findings in a patient with Guillain-Barré syndrome include:

  1. diminished breath sounds.
  2. crackles.
  3. tracheal deviation.
  4. depressed diaphragms.
A
  1. diminished breath sounds.

2. crackles.

60
Q

A Guillain-Barré syndrome patient has autonomic nervous system dysfunction which can result in all of the following EXCEPT:

a. tachycardia.
b. hypotension.
c. urinary retention.
d. fever.

A

fever.

61
Q

A patient with Guillain-Barré syndrome developed atelectasis. His chest radiograph findings would be expected to show:

a. “ground-glass” appearance.
b. “honeycombing.”
c. increased opacity.
d. blunted costophrenic angles.

A

increased opacity.

62
Q

Approximately what percentage of patients with GBS develop respiratory muscle paralysis?

A

10% to 30%

63
Q

Which of the following are identified as the causative organisms of the respiratory or gastrointestinal infections that precede the onset of most cases of GBS?

a. Chlamydia psittaci and Campylobacter jejuni
b. Cytomegalovirus and mononucleosis
c. Campylobacter jejuni and cytomegalovirus
d. Mononucleosis and parainfluenza 2

A

Campylobacter jejuni and cytomegalovirus

64
Q

In the United States and Europe, what is the most common subtype of GBS?

A

Acute inflammatory demyelinating polyneuropathy (AIDP)

65
Q

Which of the following are associated with myasthenia gravis?

  1. It interferes with acetylcholine transmission.
  2. It causes weakness of voluntary muscles.
  3. It is usually an ascending paralysis starting in the legs.
  4. It is usually preceded by a viral infection.
A
  1. It interferes with acetylcholine transmission.

2. It causes weakness of voluntary muscles

66
Q

What clinical change would be expected following a rest period for a patient with myasthenia gravis?

A

Muscle strength improves.

67
Q

The major pathologic or structural changes of the lungs associated with myasthenic crisis include:

  1. alveolar consolidation.
  2. airway obstruction.
  3. mucus accumulation.
  4. atelectasis.
A
  1. alveolar consolidation.
  2. airway obstruction.
  3. mucus accumulation.
  4. atelectasis.
68
Q

Which demographic group(s) is/are most likely to develop myasthenia gravis?

A
  1. Females 15 to 35 years of age

4. Males 40 to 70 years of age

69
Q

Which of the following is (are) signs and symptoms associated with myasthenia gravis?

  1. Double vision
  2. Weakness of neck muscles
  3. Drooping of eyelids
  4. Difficulty speaking
A
  1. Double vision
  2. Weakness of neck muscles
  3. Drooping of eyelids
  4. Difficulty speaking
70
Q

What test is usually performed to confirm the diagnosis of myasthenia gravis?

A

RNS repetitive nerve stimulation (RNS)

71
Q

If a patient with myasthenia gravis is given edrophonium, what response would be expected?

A

Strength will temporarily improve for 10 minutes.

72
Q

Which of the following values would be associated with impending ventilatory failure in a patient with myasthenia gravis?

  1. NIF –15cm H2O
  2. VC 10 mL/kg
  3. PaCO2 43 mm Hg
  4. pH 7.36
A
  1. NIF –15cm H2O

2. VC 10 mL/kg

73
Q

Which of the following are among the treatment options for the patient with myasthenia gravis?

  1. Pyridostigmine (Mestinon)
  2. Plasmapheresis
  3. Thymectomy
  4. Mechanical ventilation
A
  1. Pyridostigmine (Mestinon)
  2. Plasmapheresis
  3. Thymectomy
  4. Mechanical ventilation
74
Q

Complications commonly associated with long-term use of steroids in the management of myasthenia gravis include all of the following EXCEPT:

a. infections.
b. cataracts.
c. pulmonary edema.
d. osteoporosis.

A

pulmonary edema.

75
Q

A 50-kg (110-lb) 30-year-old female patient has myasthenia gravis. Bedside spirometry has found her VC to be 700 mL and NIF –14 cm H2O. Vital signs show a respiratory rate of 38 breaths/min, a heart rate of 140/minute, and blood pressure of 130/90 mm Hg. What should the respiratory therapist recommend?

A

Initiate mechanical ventilation per protocol.

76
Q

A physician recommended a thymectomy for a patient with generalized myasthenia gravis. The primary benefit of this procedure is to:

A

eliminate the source of AChR antibodies.

77
Q

A patient has a severe case of generalized myasthenia gravis. It is most important that the patient be monitored for:

A

apnea.

78
Q

A patient with myasthenia gravis will have lung volume and capacity findings that indicate a(n):

A

restrictive pulmonary disorder.

79
Q

During a myasthenia crisis, a patient was placed on mechanical ventilation but is now stable. What will the chest radiograph most likely show?

A

Normal lungs

80
Q

Which of the following disrupt(s) the nerve impulse transmission in myasthenia gravis?

A

IgG antibodies

81
Q

What percentage of patients with only ocular myasthenia gravis are seropositive?

A

50%

82
Q

What is the most sensitive diagnostic test for myasthenia gravis

A

SFEMG

83
Q

In which clinical classification of myasthenia gravis is intubation indicated?

a. Class I
b. Class 1IIb
c. Class V
d. Class II

A

Class V

MI Clinical Manifestations and Assessment of Respiratory Disease (4 decks)

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