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RET1293 > Ch.1-6 > Flashcards

Ch.1-6 Flashcards

1
Q

What is the purpose of the patient history?

A

To gather pertinent historical subjective and objective data.

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2
Q

The ___________ is a meeting between the respiratory care practitioner and the patient.

A

Interview

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3
Q

What are the most important components of a successful interview?

A

Communication and understanding

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4
Q

What is the art of viewing the world from the patient’s point of view while remaining separate from it?

A

Empathy

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5
Q

___________ is defined as the patient’s capacity to obtain, process and understand basic health information and services and needed to make appropriate health decisions and follow instructions for treatment.

A

Health Literacy

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6
Q

During the interview, what should the examiner observe?

A
  • Patient’s body language
  • Note patient’s facial expressions
  • Eye movement
  • Pain grimaces
  • Restlessness and sighing
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7
Q

Explain “white coat syndrome”

A

Anxiety patients get from simply being in the hospital and interacting with various professional staff members about health issues, test results and medical procedures. The patient can be intimidated to the point of shutting down and fail to ask questions or learn from the interview.

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8
Q

What can be defined as the values, beliefs and practices shared by the majority in a group of people?

A

Culture

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9
Q

What refers to a formalized system of belief and worship?

A

Religion

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10
Q

_______ entails the spirit, or soul, and is an element of religion.

A

Spirituality

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11
Q

__________ involves the knowledge of the patient’s history and ancestry and an understanding of the patient’s beliefs, artistic expressions, diets, celebrations and rituals.

A

Cultural awareness

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12
Q

_______________ refers to refraining from using offensive language, respecting accepted and expected ways to communicate, and not speaking disrespectfully of a person’s cultural beliefs.

A

Cultural sensitivity

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13
Q

_____________ refers to knowing the health care practitioner’s own values, attitudes, beliefs and prejudices, while at the same time, keeping an open mind and trying to view the world through the perspective of culturally diverse groups and people.

A

Cultural competence

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14
Q

It is estimated that more than ___% of adults in the United States have basic or below acceptable basic health literacy. In other words, nearly 9 in 10 adults lack the skills needed to manage their health and prevent disease.

A

85

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15
Q

What is used to echo the patient’s words?

A

Reflection

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16
Q

The _____________ is the final overview of the examiner’s understanding of the patient’s statements.

A

Summary

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17
Q

What is used when the patient’s choice of words is ambiguous or confusing?

A

Clarification

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18
Q

To enhance the accuracy of written and oral information, what is the best strategy?

A

Plain language approach

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19
Q

What type of question asks the patient to provide narrative information?

A

Open-ended questions

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20
Q

_________ encourages patients to say more, to continue the story.

A

Facilitation

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21
Q

____________ is affective after an open-ended question.

A

Silent attentiveness

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22
Q

_______________ is the use of impersonal conversation that places space between a frightening topic and the speaker.

A

Distance

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23
Q

When are open-ended questions commonly used?

A
  • To begin interview
  • Introduce a new section of questions
  • To gather further information whenever the patient introduces a new topic
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24
Q

What type of question is unbiased and allows the patient to answer in any way?

A

Open-ended questions

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25
Q

What type of question asks the patient for specific information?

A

Closed or direct questions

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26
Q

What type of questions speed up the interview process and are often useful in emergency situations when the patient is unable to speak in complete sentences?

A

Closed or direct questions

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27
Q

__________ is defined as the identification of oneself with another and the resulting capacity to feel or experience sensations, emotions or thoughts similar to those being experienced by another person.

A

Empathy

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28
Q

What are some examples of facilitating responses?

A

“Mm hmm”, “Go on”, “Continue”, “Uh huh”
Nonverbal cues such as maintaining eye contact and shifting forward in the seat.

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29
Q

_________ communicates that the patient has time to think and organize what he or she wishes to say without interruption by the examiner.

A

Silence

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30
Q

In using ___________, the examiner notes a certain action, feeling, or statement made by the patient and focuses the patient’s attention on it.

A

Confrontation

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31
Q

Nonverbal techniques include:

A
  • Physical appearance
  • Posture
  • Gesture
  • Facial expressions
  • Eye contact
  • Voice and touch
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32
Q

What type of position sends a defensive and anxious message?

A

Closed position, with arms and legs crossed

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33
Q

An open position shows ____________________.

A

relaxation, physical comfort and willingness to share information

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34
Q

Slow speech with long and frequent pauses, combined with a weak and monotonous tone voice suggests ___________.

A

Depression

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35
Q

What are the four major vital signs?

A
  1. Body Temperature
  2. Pulse
  3. Respiratory Rate
  4. Blood Pressure
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36
Q

In many patient care settings, what is considered to be the “fifth vital sign”?

A

Oxygen saturation as measured by pulse oximetry (SpO2)

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37
Q

Body temperature is routinely measured to assess for signs of what?

A

Inflammation or Infection

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38
Q

The temperature inside the body, the core temperature remains relatively constant - what is the temperature?

A

37°C (98.6°F)

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39
Q

What is the average cardiac output in the resting adult?

A

Approximately 5 L/min

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40
Q

Fast, deep respirations with (abrupt, irregular) pauses

A

Biot’s respirations

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41
Q

When the chest is percussed over areas of trapped gas, what type of sound is heard?

A

Hyperresonant note

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42
Q

A decrease in body temperature causes ____________, which works to keep warmed blood closer to the center of the body, thus working to maintain the core temperature.

A

Vasoconstriction

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43
Q

According to estimates, for every 1°C increase in the body temperature, the patient’s oxygen consumption increases about ______%

A

10

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44
Q

A patient who has a temperature within the normal range is said to be ______________.

A

Afebrile

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45
Q

A body temperature above normal range is called ______________.

A

Pyrexia or hyperthermia

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46
Q

When the body temperature rises above the normal range, the patient is said to have a ______________.

A

Fever, or they’re febrile

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47
Q

An exceptionally high temperature, such as 41°C (105.8°F) is called what?

A

Hyperpyrexia

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48
Q

What are the four common types of fevers?

A
  • Intermittent fever
  • Remittent fever
  • Relapsing fever
  • Constant fever
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49
Q

When the patient’s body temperature alternates at regular intervals between periods of fever or normal below-normal temperatures. What type of fever is this?

A

Intermittent fever

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50
Q

The patient has marked peaks and valleys (more than 2°C [3.6°F]) over a 24-hour period, all of which are above normal. What type of fever is this?

A

Remittent fever

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51
Q

This fever is present when the patient’s body temperature remains above normal with minimal or no fluctuation. What type of fever is this?

A

Constant fever.

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52
Q

When short febrile periods of a few days are interspersed with 1 or 2 days of normal temperature. What type of fever is this?

A

Relapsing fever

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53
Q

Hypothermia may occur as a result of what?

A
  • Excessive heat loss
  • Inadequate heat production to counteract heat loss
  • Impaired hypothalamic thermoregulation
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54
Q

Describe the diaphragm when severe alveolar hyperinflation is present.

A

It is low and flat in position and has minimal excursion.

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55
Q

What are some clinical signs of hypothermia?

(Up to 11 answers)

A
  • Below normal body temperature
  • Decreased pulse and respiratory rate
  • Severe shivering
  • Patient indicating coldness and presence of chills
  • Pale or bluish, cool waxy skin
  • Hypotension
  • Decreased urinary output
  • Lack of muscle coordination
  • Disorientation
  • Coma
  • Drowsiness or unresponsiveness
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56
Q

Accidental hypothermia is commonly seen in what type of patients?

A
  • Those who have been immersed in a cold liquid environment for a prolonged time
  • Those who have had an excessive exposure to a cold environment
  • Has inadequate clothing, shelter or heat.
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57
Q

In clinical settings the pulse is usually assessed by what?

A

Palpatation

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58
Q

The characteristics of the pulse are described in terms of what?

A

Rate, rhythm and strength

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59
Q

What are the nine common pulse sites?

A
  • Temporal
  • Carotid
  • Apical
  • Brachial
  • Radial
  • Femoral
  • Popliteal
  • Pedal (Dorsalis pedis)
  • Posterior tibial area
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60
Q

What is the normal pulse rate for an adult?

A

60-100 BPM

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61
Q

What is the primary muscle of respiration?

A

Diaphragm

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62
Q

What is defined as a systolic blood pressure that is more than 10 mmHg lower on inspiration than on expiration?

A

Pulsus paradoxus

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63
Q

What is used to establish an immediate baseline SpO2 value?

A

Oxygen saturation

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64
Q

Tachycardia may occur as a result of what?

A
  • Hypoxemia
  • Anemia
  • Fever
  • Anxiety
  • Emotional stress
  • Fear
  • Hemorrhage
  • Hypotension
  • Dehydration
  • Shock
    - Also a common side effect in patient receiving certain medications such as sympathomimetic agents
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65
Q

Normally, the ventricular contraction is under the control of the ___________, which generates a normal rate and regular rhythm.

A

Sinus node in the atrium

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66
Q

In child and young adults, it is not uncommon for the heart rate to increase during inspiration and decrease during exhalation. What is this called?

A

Sinus arrhythmia

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67
Q

The quality of the pulse reflects the strength of what?

A

The left ventricular contraction and volume of blood flowing to the peripheral tissues

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68
Q

Pulsus paradoxus is common among patients experiencing what?

A

Severe asthmatic episodes

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69
Q

Where can bradycardia be seen?

A
  • Patients with hypothermia
  • In physically fit athletes
  • It also may be lower than expected when the patient is at rest or asleep as a result of head injury, drugs such as beta- blockers, vomiting or advanced age.
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70
Q

What are some things that can cause the heart to beat irregularly?

A

Inadequate blood flow and oxygen supply to the heart or an electrolyte imbalance can cause heart to beat irregularly

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71
Q

Clinically, the strength of the pulse may be recorded on a scale of ________.

A

0 to 4+

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72
Q

What may be used for peripheral pulses that are difficult to detect by palpation?

A

ultrasonic Doppler device

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73
Q

Under normal conditions, ___________ is a passive process.
Answer choices:
1. Inspiration
2. Expiration

A

Expiration

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74
Q

Inspiration is an active process whereby the diaphragm contracts and causes ____________ to decrease.

A

Intrathoracic pressure

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75
Q

What happens at the end of inspiration?

A

Diaphragm relaxes and the natural lung elasticity causes the pressure in the lung to increase. This action causes air to flow out of the lung.

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76
Q

What is the normal RR for an adult?

A

12-20 breaths per min

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77
Q

Where is tachypnea commonly seen?

A
  • Fever
  • Metabolic acidosis
  • Hypoxemia
  • Pain
  • Anxiety
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78
Q

Bradypnea may occur with what?

A
  • Hypothermia
  • Head injuries
  • Drug overdose
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79
Q

What is the force exerted by the circulating volume of blood on the walls of the arteries?

A

Arterial blood pressure

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80
Q

The blood pressure measured during ventricular contraction (cardiac systole) is the ________________.

A

Systolic blood pressure

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81
Q

Blood flow is equal to _______________.

A

Cardiac output

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82
Q

During ventricular relaxation, blood pressure is generated by the elastic recoil of the arteries and arterioles. What is this called?

A

Diastolic blood pressure

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83
Q

Label the scale to rate pulse quality

A

0: Absent or no pulse detected
1+: Weak, thready, difficult to feel
2+: Pulse difficult to palpate
3+: Normal pulse
4+ Bounding, easily palpated and difficult to obliterate

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84
Q

Respirations that progressively become faster and deeper, followed by respirations that progressively become slower and shallower and ending with a period of apnea.

A

Cheyne-Stokes respiration

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85
Q

What is the normal systolic blood pressure range for an adult?

A

110-140 mmHg

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86
Q

The numeric difference between the systolic and diastolic pressure is called the ________________________.

A

Pulse pressure

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87
Q

Blood pressure is the function of:
1. _________________________
2. _________________________

A
  1. The blood flow generated by ventricular contraction
  2. The resistance to blood flow caused by the vascular system
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88
Q

Cardiac output is equal to the product of what?

A

The volume of blood ejected from the ventricles during each heartbeat (stroke volume) multiplied by the heart rate.

CO=SV x HR)

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89
Q

Decreased rate and depth, which decreases alveolar ventilation and leads to an increased PaCO2

A

Hypoventilation

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90
Q

Increased rate and depth, which increases alveolar ventilation and leads to an decreased PaCO2

A

Hyperventilation

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91
Q

Increased depth and rate of breathing. Commonly considered normal during periods of exercise to meet metabolic needs.

A

Hyperpnea

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92
Q

Friction between the blood components and the vessel walls is inversely related to ____________________.

A

The dimensions of the vessel lumen (size).

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93
Q

What happens when the vessel lumen narrows or constricts?

A

Vascular resistance increases

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94
Q

An elevated blood pressure of an unknown cause is called ___________.

A

Primary hypertension

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95
Q

What are some factors associated with hypertension?

A
  • Arterial disease
  • Obesity
  • High serum sodium level
  • Pregnancy
  • Obstructive sleep apnea
  • Family history of high blood pressure
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96
Q

An elevated blood pressure with a known cause is called ___________.

A

Secondary hypertension

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97
Q

Hypertension may lead to what?

A

Congestive Heart Failure

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98
Q

Hypotension is said to be present when the patient’s blood pressure falls below _________.

A

90/60 mmHg

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99
Q

What is hypotension associated with?

A
  • Peripheral vasodilation
  • Decreased vascular resistance
  • Hypovalemia
  • Left ventricular failure
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100
Q

_____________ occurs when blood pressure quickly drops as the individual rises to an upright position or stands.

A

Orthostatic hypotension or postural hypotension

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101
Q

What are some signs and symptoms of hypotension?

A
  • Pallor
    -Skin mottling
  • Clamminess
  • Blurred vision
  • Confusion
  • Dizziness
  • Syncope
  • Chest pain
  • Increased heart rate
  • Decreased urine output
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102
Q

What is orthostatic hypotension associated with?

A
  • Decreased blood volume
  • Anemia
  • Dehydration
  • Prolonged bed rest
  • Antihypertensive medications
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103
Q

What is normal SpO2 range values?

A

95-99%

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104
Q

What is mild hypoxemia SpO2 range values?

A

91-94%

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105
Q

What is moderate hypoxemia SpO2 range values?

A

86-90%

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106
Q

What is severe hypoxemia SpO2 range values?

A

85% or LOWER!

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107
Q

Anteriorly, the first rib attached to the manubrium just beneath the ______________.

A

Clavicle

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108
Q

The __________ and its cartilage are attached to the sternum just above the xiphoid process.

A

sixth rib

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109
Q

What equally divides the anterior chest into the left and right hemithoraces?

A

The vertical midsternal line

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110
Q

________ runs parallel to the sternum, traditionally down through the male nipple.

A

Midclavicular lines

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111
Q

Posteriorly, the ___________ runs along the spinous processes of the vertebrae.

A

Vertebral line, also called the midspinal line

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112
Q

Anteriorly, the apex of the lung extends approximately _______ above the medial third of the clavicle.

A

2-4 cm

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113
Q

Under normal conditions the lungs extend down to about the level of the __________.

A

sixth rib

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114
Q

The right lung is separated into the upper, middle, and lower lobes by what?

A
  • Horizontal fissure
  • Oblique fissure
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115
Q

The left lung is separated into the upper and lower lobes by the _________.

A

Oblique fissure

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116
Q

The ______________ of the patient is an ongoing observational process that beings with the history and continues throughout the patient interview, taking vital signs and physical examination.

A

Inspection

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117
Q

_____________ is the process of touching the patient’s chest to evaluate the symmetry of chest expansion, the position of the trachea, skin temperature, muscle tone, areas of tenderness, lumps, depressions and tactile fremitus and vocal fremitus.

A

Palpation

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118
Q

What are some abnormal pulmonary conditions that may cause the trachea to deviate from its normal position?

A

May push trachea to unaffected side:
- Tension pneumothorax
- Pleaural effusion
- Tumor mass
May push trachea towards affected side:
- Atelectasis
- Pulmonary fibrosis

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119
Q

The symmetry of chest expansion is evaluated by lightly placing each hand over the patient’s posterolateral chest so that the thumbs meet at the midline at about __________________.

A

the T-8 to T-10 level.

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120
Q

With chest excursion, each thumb tip normally moves equally about _________ from the midline.

A

3-5 cm

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121
Q

Vibration that can be perceived by palpation over the chest is called _________.

A

Tactile fremitus, also known as rhonchial fremitus

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122
Q

Bilaterally decreased chest expansion may be caused by what?

A

Both an obstruction and restrictive lung disorder

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123
Q

An unequal chest expansion may occur when one or more of the following develop in or around one lung only:

A
  • Alveolar consolidation
  • Lobar atelectasis
  • Pneumothorax
  • Large pleural effusions
  • Chest trauma
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124
Q

___________ over the chest wall is performed to determine the size, borders and consistency of air, liquid or solid material in the underlying lung.

A

Percussion

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125
Q

What is generated through the vascular system with each ventricular contraction of the heart (systole)?

A

A pulse

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126
Q

What are some factors that affect body temperature?

A
  • Age
  • Environment
  • Time of day
  • Exercise
  • Stress
  • Hormones
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127
Q

What are some common therapeutic interventions for hypothermia?

A
  • Remove wet clothing
  • Provide dry clothing
  • Place patient in warm environment (slowly increase room temperature)
  • Cover patient with warm blankets or electric heating blanket
  • Apply warming pads
  • Keep patient’s limbs close to body
  • Cover patient’s head with cap or towel
  • Supply warm oral or IV fluids
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128
Q

What is the term used to describe a core temperature below the normal range?

A

Hypothermia

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128
Q

_________________ refers to the intentional lowering of a patient’s body temperature to reduce the oxygen demand of the tissue cells.

A

Induced hypothermia

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129
Q

What is heard when the chest is percussed over areas of pleural thickening, pleural effusion, atelectasis and consolidation?

A

Dull percussion note

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130
Q

What is the other name for subcutaneous emphysema?

A

Crepitus

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131
Q

What are the three normal breath sounds called?

A
  • Bronchial breath sounds
  • Bronchovesicular breath sounds
  • Vesicular breath sounds
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132
Q

What are some factors that affect blood pressure?

A
  • Age
  • Exercise
  • Autonomic nervous system
  • Stress
  • Circulating blood volume
  • Medications
  • Normal fluctuations
  • Race
  • Obesity
  • Diurnal - BP is usually lowest in the morning, when the metabolic rate is lowest.
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133
Q

____________ of the chest provides information about the heart, blood vessels, and air flowing in and out of the tracheobronchial tree and alveoli.

A

Auscultation

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134
Q

Abnormal lung sounds are also called ____________________.

A

Adventitious lung sounds

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135
Q

What type of breath sounds are auscultated directly over the trachea and are caused by the turbulent flow of gas through the upper airway?

A

Bronchial breath sounds

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136
Q

What type of breath sound are normal sounds of gas rustling or swishing through the small bronchioles and the alveoli?

A

Vesicular breath sounds

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137
Q

An increase in body temperature causes the blood vessels near the skin surface to dilate. What is this process called?

A

Vasodilation

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138
Q

When is induced hypothermia usually indicated?

A
  • Before certain surgeries, such as heart or brain surgery or after ROSC after a cardiac arrest
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139
Q

Body temperature normally varies throughout the day, this phenomenon is called ___________.

A

Diurnal variation

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140
Q

What are the 4 commonly used sites for BP?

A
  • Oral (Mouth)
  • Rectum
  • Axillary
  • Tympanic (Ear)
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141
Q

Before taking an oral temperature, how long should the practitioner wait after a patient has ingested ice water?

A

15 minutes

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142
Q

Drinking ice water may lower a patient’s oral temperature by how much?

A

0.2 to 1.6°F

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143
Q

In patients with irregular, abnormally slow, or fast cardiac rhythms, the pulse rates should be counted for how long?

A

1 minute

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144
Q

A increased heart rate combined with a large blood volume will generate what type of pulse?

A

Full, bounding pulse

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145
Q

A weak ventricular contraction combined with an inadequate blood volume will result in what type of pulse?

A

Weak, thready pulse

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146
Q

A normal left ventricular contraction with an inadequate blood volume will generate what type of pulse?

A

Strong, throbbing pulse

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147
Q

When the strength of a pulse varies every other beat while the rhythm remains regular. What is this called?

A

Pulsus alternans

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148
Q

During normal sinus rhythm, the heart rate can be obtained through auscultation by placing the stethoscope over ________________.

A

The apex of the heart

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149
Q

What monitors and regulates vascular tone?

A

Autonomic nervous system

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150
Q

The physical examination of the chest and lungs should be performed in a systemic and orderly fashion. What’s the common sequence?

A
  • Inspection
  • Palpation
  • Percussion
  • Auscultation
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151
Q

To evaluate the position of the trachea, the examiner places an index finger over the ___________ and gently moves it from side to side.

A

Sternal notch

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152
Q

What condition is commonly caused by gas flowing through thick secretions that are partially obstructing the large airways?

A

Tactile fremitus

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153
Q

Where is fremitus sounds most promininent?

A

Between the scapulae and around the sternum, sites where the bronchi are closest to the chest wall

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154
Q

Which abnormal percussion note is similar to the sound produced by knocking on a full barrel?

A

A dull percussion note

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155
Q

Which type of note is elicited from air trapping in the patient with chronic obstructive pulmonary disease or pneumothorax?

Remember air trapping!!
- Lung hyperinflation (COPD)
- Lung collapse (pneumothorax)
- Air trapping (asthma)

A

Hyperresonant note

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156
Q

What would happen to the diaphragm in a patient with lobar collapse of one lung?

A

Diaphragm would be pull up affected side and reduce excursion.

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157
Q

What would happen to the diaphragm in a patient with a neuromuscular disease?

A

Diaphragm would be elevated and immobile

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158
Q

Where is the location of bronchial breath sounds?

A

Over the trachea
Pitch: High
Intenstity: Loud

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159
Q

Where is the location of bronchovesicular breath sounds?

A

Upper portion of anterior sternum, between scapulae
Pitch: Moderate
Intenstity: Moderate

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160
Q

Where is the location of vesicular breath sounds?

A

Peripheral lung regions
Pitch: High
Intenstity: Low

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161
Q

What type of breath sounds are auscultated directly over the mainstem bronchi and do not have a pause between the inspiratory and expiratory phase?

A

Bronchovesicular

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162
Q

Are vesicular breaths sounds heard primarily during inspiration or expiration?

A

Inspiration

163
Q

What should be included when documenting ALS (abnormal lung sounds)?

A
  • For intensity or loudness, use words like faint, soft, moderate or loud
  • The part of the respiratory cycle
  • Document the magnitude (small, scant or profuse crackles)
  • Always include the precise location over the chest
164
Q

What does stridor indicate?

A

Swollen larynx or airway

165
Q

What does pleural friction rub indicate?

A

Inflammation of pleural membranes (pleurisy)

166
Q

What does coarse crackles indicate?

A

Airway secretions

Associated with the following pathologic conditions:
- Severe COPD
- CF
- Bronchiectasis
- CHF (Pulmonary edema)

167
Q

What does fine crackles indicate?

A

- Atelectasis (Loss of lung volume)
- Alveolar fluid
- Interstitial fibrosis (asbestosis)
- Early stage of CHF
- Interstitial edema (early pulmonary edema)

168
Q

What does diminished breath sounds indicate?

A

Alveolar hyperinflation

169
Q

What does wheezes indicate?

A

Smooth muscle constriction

170
Q

What does bronchial breath sounds indicate?

A

Alveolar consolidation and/or collapse (atelectasis)

171
Q

Voluntary decrease in tidal volume to decrease pain on chest expansion. What is this called?

A

Splinting

172
Q

Leaning forward with arms and elbows supported on overbed table. What is this called?

A

Tripod position; inability to lie flat

173
Q

An individual’s normal breathing pattern is composed of:
(3 things)

A
  • Tidal Volume (VT)
  • Ventilatory rate
  • I:E ratio
174
Q

In normal adults, tidal volume is about _____________.

A

500 mL (7 to 9 mL/kg)

175
Q

In normal adults, the ventilatory rate is about ____.

A

15 breaths per minute. (with a range of 12-18)

176
Q

In normal adults, the I:E ratio is ______.

A

1:2

177
Q

________ is defined as the “breathlessness” or “shortness of breath” or the “labored or difficult breathing” felt and described only by the patient.

A

Dyspnea

178
Q

What are some signs of dyspnea?

A
  • Audibly labored breathing
  • Hyperventilation
  • Tachypnea
  • Retractions of intercostal spaces
  • Use of accessory muscles
  • Distressed facial expression
  • Flaring of nostrils
  • Paradoxical movements of the chest and abdomen
  • Gasping
179
Q

Dyspnea that occurs only when the patient is in the reclining position.

A

Positional dyspnea, also called orthopnea

180
Q

Labored breathing caused by heart disease. What type of dyspnea is this?

A

Cardiac dyspnea

181
Q

Dyspnea that is provoked by physical exercise or exertion

A

Exertional dyspnea

181
Q

Difficulty breathing as a result of kidney disease

A

Renal dyspnea

182
Q

A form of respiratory distress related to posture (especially reclining while sleeping) and is usually associated with CHF with pulmonary edema

A

Paroxysmal nocturnal dyspnea

183
Q

What is the Modified (British) Medical Research Council Questionnaire used for?

A

Assessing the severity of breathlessness in those who can speak

184
Q

What is the Borg Dyspnea scale used for?

A

Assessing the severity of breathlessness in those who cannot speak because of mouthpieces, endotracheal tubes, tracheostomies, etc

185
Q

The ease with which the elastic forces of the lungs accepts a volume of inspired air is known as ________________.

A

Lung compliance

186
Q

____________________ is defined as the pressure difference between the mouth and the alveoli divided by the flow rate.

A

Airway resistance

187
Q

What determines how much air in liters the lungs will accommodate for each centimeter or water pressure change in distending pressure?

A

Compliance

188
Q

A rapid rate of breathing and reduced tidal volume is commonly seen during ________ when the alveoli are overinflated.

A

Early stages of an acute asthmatic attack

189
Q

Under normal conditions, what is the airway resistance (Raw) in the tracheobronchial tree?

A

About 1.0 to 2.0 cmH2O/L/s

190
Q

In large airway obstructive diseases (e.g., bronchitis, asthma), is airway resistance high or low?

A

Extremely high

191
Q

Even the slightest reduction in airway diameter can have a remarkable effect on the patient’s ability to move in and out of the lungs. According to whose law?

A

Poisueille

192
Q

In physics, work is defined as the force multiplied by _________.

A

The distanced moved. (work= force x distance)

193
Q

In respiratory physiology, what may be used to quantify the work of breathing?

A

The change in pulmonary pressure (force) multiplied by the change in lung volume (distance)

work= pressure x volume

194
Q

What is a major cause of dyspnea?

A

Hypoxemia and the stimulation of the peripheral chemoreceptors (also called carotid or aortic bodies)

195
Q

In respiratory disease, a decrease arterial oxygen level is the result of what?

A
  • Ventilation-perfusion ratio
  • Pulmonary shunting
  • Venous admixutre
196
Q

Although the peripheral chemoreceptors are stimulated whenever the PaO2 is less than normal, they are generally most active when the PaO2 falls below _____.

A

60 mmHg (SaO2 <88%)

197
Q

Suppression of peripheral chemoreceptors are seen when PaO2 falls below ____.

A

30 mmHg

198
Q

Which two groups are responsible for coordinating respiration?

A
  • Dorsal respiratory group (DRG)
  • Ventral respiratory group (VRG)
199
Q

It should be noted that in patients who have a ____________, the peripheral chemoreceptors are the primary receptor sites for the control of ventilation.

A
  • Chronically high PaCO2
  • Low PaO2
200
Q

Both DRG and VRG are stimulated by an increase of ________________.

A

H+ concentration in the cerebrospinal fluid.

201
Q

What is the H+ concentration monitored by?

A

Central chemoreceptors

202
Q

When the lungs are compressed or deflated (atelectasis), what type of breathing is seen?

A

increased rate of breathing

203
Q

When the lungs are compressed, deflated or exposed to noxious gases, which receptor is stimulated?

A

Irritant receptors

204
Q

Fever is commonly associated with infectious diseases such as:

A
  • Pneumonia
  • Lung abscess
  • TB
  • Fungal disease
205
Q

When the irritant receptors are activated, a reflex causes the ventilatory to increase or decrease?

A

Increase

May also cause a cough and bronchoconstriction

206
Q

Stimulation of which receptors triggers raid, shallow breathing?

A

Juxtapulmonary-Capillary Receptors - J receptors

207
Q

Abnormal ventilatory patterns that occur suddenly (minutes to hours maximum) are classified as ____________.

A

Acute onset conditions

208
Q

Abnormal ventilatory conditions that develop slowly (days to months) are classified as _________.

A

Chronic conditions

209
Q

What is the function of aortic and carotid sinus baroreceptors?

A
  1. Decrease heart rate and ventilatory rate in response to increased systemic BP
  2. Increase heart rate and ventilatory rate in response to decreased systemic BP
210
Q

An increased RR may result from chest pain or fear and anxiety associated with _________________.

A

Inability to breathe

211
Q

The Hering-Breur reflex does NOT occur when the bronchi and bronchioles are below what temperature?

A

8°C (46.4°F)

212
Q

What are the major muscles of inspiration?

A
  • Scalenes
  • Sternocleiodomastoid
  • Pectoralis major muscle groups
  • Trapezius muscle groups
213
Q

During the advanced stages of chronic obstructive pulmonary disease, the diaphragm ____________________.

Explain what happens to the diaphragm

A

The diaphragm becomes significantly depressed by the increased lung volumes. (RV, TLC and FRC)

214
Q

_________ assist or largely replace the diaphragm in creating subatmospheric pressure in the pleural space during inspiration.

A

The accessory muscles of inspiration

215
Q

When they are used as accessory muscles, their primary role is to elevate the first and second ribs and flex the neck.

A

Scalene muscles

216
Q

What are the major accessory muscles of expiration?

A
  • Rectus abdominis
  • External oblique
  • Internal oblique
  • Tranversus abdominis
217
Q

The ______________ are located on each side of the neck, where they rotate and support the head.

A

Sternocleidomastoids

218
Q

Which muscle rotates the scapula, raises the shoulders and abducts and flexes the arm?

A

Trapezius

219
Q

Pulling the upper part of the arm to the body in a hugging position is a function of the ________________.

A

Pectoralis major muscles

220
Q

When used as an accessory muscle of inspiration, the _________ helps elevate the thoracic cage.

A

Trapezius

221
Q

What are often recruited when airway resistance become significantly elevated?

A

Accessory muscles of expiration

222
Q

When __________ is activated, the muscles assist in compressing the abdominal contents, which in turn push the diaphragm into the thoracic cage.

A
  • Rectus abdominis
  • Internal oblique
  • External oblique (during exhalation)
223
Q

Which muscle is the longest and most superficial of all the anterolateral muscles of the abdomen?

A

External Obliques

224
Q

What happens when all four accessory muscles of expiration contract?

A

The abdominal pressure increases and drives the diaphragm into the thoracic cage. As the diaphragms moves during inhalation, the intrapleural pressure increases and enhances expiratory gas flow.

225
Q

Pursed-lip breathing occurs in patients during _____________.

A

The advances stages of obstructive pulmonary disease

226
Q

Where is nasal flaring commonly seen?

A

In infants experiencing respiratory distress

227
Q

_______ is usually described as a sudden, sharp or stabbing pain.

A

Pleuritic chest pain

228
Q

In an effort to overcome the low lung compliance, the patient must generate a greater-than-normal negative intrapleural pressure during inspiration.

A

Substernal and Intercostal retractions

228
Q

Where is substernal and Intercostal retractions commonly seen?

A

Newborns with respiratory disorder like:
- RDS
- Meconium aspiration syndrome
- Transient tachypnea of newborn
- Bronchopulmonary dysplasia
- Congenital diaphragmatic hernia

229
Q

When activated, the _______ pulls the alae laterally and widens the nasal aperture, providing a larger orifice for gas to enter the lungs during inspiration.

A

dilator naris

230
Q

What is one of the most common complaints among patients with cardiopulmonary issues?

A

Chest pain

231
Q

Severe resistance to taking a deep breath is called _____________.

A

Splinting

232
Q

________________ is described as a constant pain that is usually located centrally.

A

Nonpleuritic chest pain

233
Q

Nonpleuritic chest pain is associated with the following disorders:

A
  • Myocardial ischemia
  • Pericardial inflammation
  • Pulmonary hypertension
  • Esophagitis
  • Local trauma or inflammation of the chest cage, muscles, bones or cartilage
234
Q

When the normal 14-15 g/dL of hemoglobin is fully saturated, the PaO2 is about _________.

A

97-100 mmHg and about 20 mL/dL of O2 in the blood

235
Q

In a typical cyanotic patient with one-third (5g/dL) of the hemoglobin reduced, the PaO2 is about _______.

A

30 mmHg and there is about 13 mL/dL of O2 in the blood

236
Q

The recognition of cyanosis depends on:

A
  • The acuity of the observer
  • Light conditions in the examining room
  • Pigmentation of the patient
237
Q

Pleuritic chest pain is a characteristic feature of which respiratory diseases?

A
  • Pneumonia
  • Pleural effusion
  • Pneumothorax
  • Pulmonary infarction
  • Lung cancer
  • Pnuemoconiosis
  • Fungal diseases
  • TB
238
Q

In a patient with polycythemia, cyanosis may be present at a PaO2 well above 30 mmHg because _________________________.

A

The amount of reduced hemoglobin is often greater than 5 g/dL in these pts, even when their oxygen content is within normal limits.

239
Q

In respiratory diseases, cyanosis is the result of what?

A
  • A decreased V/Q
  • Pulmonary shunting
  • Venous admixture
  • Hypoxemia
240
Q

What are some things associated with digital clubbing?

A
  • Circulating vasodilators
  • Chronic infection
  • Unspecified toxins
  • Arterial hypoxemia
  • Local hypoxia
  • Capillary stasis
241
Q

Where is bilateral, dependent pitting edema commonly seen?

A

Patients with CHF, cor pulmonale and hepatic cirrhosis

242
Q

The wall of the tracheobronchial tree is composed of what three layers?

A
  • An epithelial lining
  • Lamina propria
  • Cartilaginous layer
243
Q

What covers the epithelial lining of the tracheobronchial tree?

A

A mucous layer, commonly referred as the mucous blanket

244
Q

How would a health care practitioner assess the presence and severity of pitting peripheral edema?

A

By placing a finger or fingers over the tibia or medial malleolus (2 to 4 inches above the foot), firmly depress the skin for seconds and then release. Normally there should be no indentation, but a pit may be seen if the person has been standing all day or is pregnant.

245
Q

What scale is peripheral pitting edema measured on?

A

1+ (mild, slight depression) to 4+ (severe, deep depression)

246
Q

The epithelial lining is separated from the lamina propria by a ____________________.

A

Basement membrane

247
Q

What is the epithelial lining predominantly composed of?

A

Psuedostratified, ciliated columnar epithelium

248
Q

The mucous blanket is ____% water.

A

95

249
Q

The mucous blanket is produced by what?

A

Goblet cells and the submucosal, or bronchial glands

250
Q

_________ is the coughing up of blood or blood-tinged sputum from the tracheobronchial tree.

A

Hemoptysis

251
Q

A sudden, audible expulsion of air from the lungs

A

Cough

252
Q

The ________ is an important cleansing mechanism of the tracheobroncial tree.

A

Mucous blanket

253
Q

The submucosal glands are particularly numerous in the medium-sized bronchi and disappear in the _____________.

A

Bronchioles

254
Q

The submucosal glands are innervated by parasympathetic nerve fibers and normally produced how much of clear, thin bronchial secretions per day?

A

100 mL

255
Q

Sputum analysis: Brown/Dark

A

Old blood

256
Q

Sputum analysis: Bright red (hemoptysis)

A

Fresh blood (bleeding tumor, tuberculosis)

257
Q

Sputum analysis: Clear and translucent

A

Normal

258
Q

Sputum analysis: Frank hemoptysis

A

Massive amount of blood

259
Q

Sputum analysis: Green

A

Stagnant sputum or gram-negative bacteria

260
Q

Sputum analysis: Pink and frothy

A

Pulmonary edema

260
Q

Sputum analysis: Yellow or opaque

A

Presence of WBCs, bacterial infection

261
Q

Sputum analysis: Viscous

A

Thick, sticky or glutinous

262
Q

Sputum analysis: Mucoid (white/gray)

A

Asthma, chronic bronchitis

263
Q

Sputum analysis: Green and foul smelling

A

Pseudomonas or anaerobic infection

264
Q

Sputum analysis: Tenacious

A

Secretions that are sticky or otherwise tend to hold together.

264
Q

The submucosal layer of the tracheobronchial tree is the ______________.

A

Lamina propria

265
Q

Where is repeated expectoration of blood-streaked sputum seen?

A
  • Chronic bronchitis
  • Bronchiectasis
  • CF
  • PE
  • Lung cancer
  • Necrotizing infections
  • TB
  • Fungal diseases
266
Q

A cough is preceded by:

A
  1. Deep inspiration
  2. Partial closure of glottis
  3. Forceful contraction of accessory muscles of expiration to expel air from lungs.
267
Q

What is defined as coughing up to 400 to 600 mL of blood within a 24-hour period?

A

Massive hemoptysis

268
Q

Blood that originates from the upper gastrointestinal tract, usually dark coffee-ground appearance

A

Hematemesis

268
Q

A brassy cough may indicate what?

A

Tumor

269
Q

A hoarse cough indicates what?

A

Croup

270
Q

What are some common causes of NPC?

A
  • Irritation of airway
  • Inflammation of airway
  • Mucous accumulation
  • Tumors
  • Irritation of pleura
271
Q

What is the protective mechanism that clears the lungs, bronchi, or trachea of irritants and also prevents aspiration of foreign materials into the lungs?

A

Cough!

272
Q

Cough is commonly seen in respiratory disease, especially in disorders that cause ______________.

A

Inflammation of the tracheobronchial tree

273
Q

What should be apart of the objective finding in a good SOAP note?

A

Sputum volume, appearance, viscosity and odor

274
Q

Where are irritant receptors located?

A

In the pharynx, larynx, trachea and large bronchi

275
Q

Gas in the lungs is divided into how many volumes and capacities?

A
  • 4 volumes
  • 4 capacities
276
Q

When the alveoli become overdistended with gas, what is this condition called?

A

Air trapping

277
Q

Which lung volume cannot be exhaled?

A

RV - Residual volume.

278
Q

The volume of gas that normally moves into and out of the lungs in one quiet breath.

A

Tidal Volume (500 mL)

279
Q

The volume of air that can be exhaled after a maximal inspiration

A

Vital Capacity (4800 mL)

280
Q

The maximal amount of air that the lungs can accommodate.

A

Total Lung Capacity (6000 mL)

281
Q

The amount of air remaining in the lungs after a forced exhalation

A

Residual Volume (1200 mL)

282
Q

The volume of air that can be forcefully exhaled after a normal tidal volume exhalation

A

Expiratory Reserve Volume (1200 mL)

283
Q

The volume of air that can be forcefully inspired after a normal tidal volume

A

Inspiratory Reserve Volume (3100 mL)

284
Q

The lung volume at rest after a normal tidal volume exhalation

A

Functional Residual Capacity (2400 mL)

285
Q

The volume of air that can be inhaled after a normal exhalation

A

Inspiratory Capacity (3600 mL)

286
Q

______________________ are associated with pathologic conditions that alter the anatomic structures of the lungs distal to the terminal bronchioles.

A

Restrictive lung volumes and capacities

286
Q

How can residual volume and the lung capacities that contain RV be obtained?

A

Measured indirectly by:
- Open circuit nitrogen washout
- Closed circuit helium dilution
- Body plethysmography

287
Q

The total volume of gas that can be exhaled as forcefully and rapidly as possible after a maximal inspiration.

A

Forced Vital Capacity - FVC

288
Q

The maximum volume of gas that can be exhaled over a specific period of time

A

Forced Expiratory Volume Timed (FEVT)

289
Q

What is the total expiratory time necessary to perform an FVC in a healthy individual?

A

4-6 seconds

290
Q

The maximum flow rate generated during an FVC maneuver

A

Peak Expiratory Flow Rate - PEFR
10 L/s (600 L/min)

291
Q

The largest volume of gas that can be breathe voluntarily in and out of the lungs in 1 minute.

A

Maximum Voluntary Ventilation - MVV

170 L/min

292
Q

In the normal individual the FVC equals the _____________.

A

Vital capacity

293
Q

Clinically, the lungs are considered normal if the FVC and VC are within _______ of each other.

A

200 mL

294
Q

What test is most commonly used to evaluate the patient’s respiratory muscle strength at the bedside?

A

MIP, MEP, FVC and MVV

295
Q

The maximum inspiratory pressure the patient is able to generate against a closed airway

A

Maximum inspiratory pressure

296
Q

What is the MIP in a normal healthy adult?

A

-80 to -100 cmH2O

297
Q

Ideally, the MIP should be measured at the patient’s ______.

A

Residual volume - RV

298
Q

The percentage of TLC occupied by the RV.

A

RV/TLC ratio

1200/6000 = 20% (approx)

299
Q

Pathological conditions that alter the tracheobronchial tree

A

Obstructive lung disorders

300
Q

Gas that enters the alveoli during inspiration is prevented from leaving the alveoli during expiration.

A

Obstructive lung disorders

301
Q

What is the most precise method for measuring FRC and RV?

A

Body box

302
Q

What can the body box measure?

A
  • RV
  • FRC
  • Airway resistance
  • Airway conductance
303
Q

In a patient with an obstructive lung disorder, the FVC is lower than VC because of what?

A

Increased airway resistance and air trapping associated with maximal effort

304
Q

Question from the back of the book:
What is the normal average compliance of the lungs and chest wall combined?

A

0.1 L/cmH2O

305
Q

Series of discontinuous, short crackling and popping sounds, high-pitched sounds heard just before the end of inspiration.

A

Fine crackles

306
Q

Continuous high-pitched whistling sound caused by rapid vibration of bronchial walls. First evident on expiration but also possibly evident on inspiration as obstruction of airway increases.

A

Wheezes

307
Q

Series of discontinuous short, low-pitched bubbling or gurgling sounds caused by air passing through intermittently occluded by mucus, unstable bronchial wall, or fold of mucosa.
Similar to blowing through a straw under water

A

Coarse crackles

308
Q

Medium-pitched sounds over areas that usually produce a resonant sound on chest percussion.

A

Dullness/flatness

309
Q

What are some possible causes of digital clubbing?

A
  • Chronic hypoxemia
  • CF
  • Lung cancer
  • Bronchiectasis
310
Q

What are possible causes of dull/flat percussion note?

A

Increased density: Pneumonia, large atelectasis
Increased pleural space fluid: pleural effusion

311
Q

What are some causes of increased and decreased tactile fremitus?

A

Increased
- Pneumonia
- Atelectasis
- Pulmonary edema

Decreased
- Pleural effusion
- Lung hyperinflation
- Absent in pneumothorax

312
Q

In which of the following pathological conditions is transmission of the whispered voice of a patient through a stethoscope usually unclear?

A
  • Alveolar consolidation
  • Atelectasis
313
Q

In what pathologic conditions would you hear diminished breath sounds?

A
  • COPD
  • Drug overdose
  • Major sedation
  • Neuromuscular disease
  • Flail chest
  • Pleural effusion
  • PTX
314
Q

What are some possible causes of pleural friction rub?

A
  • Pleurisy
  • Pneumonia
    - Pulmonary fibrosis
  • PE
  • Thoracic surgery
315
Q

What is hypoxemia?

A

PaO2 ≤ 60 mmHg or SaO2 ≤88%

316
Q

The inspection of a patient’s extremities should include the following:

A
  • Altered skin color
  • Presence or absence of digital clubbing
  • Presence or absence of peripheral edema
  • Presence or absence of distended neck veins
317
Q

Wheezing is the characteristic sound produced by _________________.

A

Airway obstruction

318
Q

What abnormal breath sound is a cardinal finding of bronchial asthma?

A

Wheezing

319
Q

A harsh, hollow or tubular breath sound. They are loud, high in pitch and about equal duration during inspiration and expiration.

A

Bronchial breath sounds

320
Q

Under normal conditions, what is the average DLCO value for a resting man?

A

25 mL/min/mmHg

321
Q

A simple, noninvasive, effort independent test that applies oscillating pressure impulses to the lungs during normal passive breathing.

A

Impulse oscillosmetry (IOS)

322
Q

The highest pressure that can be generated during a forceful expiratory effort against an occluded airway and is recorded as a POSITIVE number in either centimeters of water or millimeters of mercury.

A

Maximum expiratory pressure (MEP)

323
Q

An MIP of ______ or greater (less negative) is a strong indicator of ventilatory support.

A

-20 cmH2O

324
Q

Where are reduced MIP values commonly seen?

A
  • Patients with neuromuscular disease
  • Chest wall deformities
  • Chronic Obstructive Pulmonary Disease (COPD)
325
Q

Ideally, the MEP is measured at _____________.

A

Maximal inspiration (near total lung capacity)

326
Q

It should be noted that a low MEP is associated with ________________.

A

Poor or inadequate cough effort

327
Q

What measures the amount of carbon monoxide that moves across the alveolar capillary membrane?

A

Pulmonary Diffusion Capacity of Carbon Monoxide - DLCO

328
Q

______________ result in a increased lung rigidity, which in turn decreases lung compliance.

A

Restrictive lung disorders

329
Q

What are the most common measurements obtained from an FVC manuever?

A
  • FEVT
  • FEV1/FVC ratio
  • FEF 200-1200
  • FEF 25-75%
  • PEFR
330
Q

What are the most common measurements obtained from an FVC manuever?

A
  • FEVT
  • FEV1/FVC ratio
  • FEF 200-1200
  • FEF 25-75%
  • PEFR
331
Q

In obstructive lung disorders, why is the FEVT decrease?

A

The time necessary to exhale a certain volume forcefully is increased

332
Q

What compares the amount of air exhaled in 1 second with the total amount exhaled during an FVC maneuver?

A

FEVT/FVC ratio

333
Q

Because the FEV1/FVC ratio is expressed as a percentage, it is commonly referred as ________________.

A

Forced expiratory flow in 1 second percentage (FEV1%)

334
Q

Airway obstruction is said to be present when the FEV1/FVC ratio is less than ______.

A

70%

335
Q

What are commonly used to assess the severity of a patient’s pulmonary disorder and determine whether has an obstructive or restrictive lung disorder?

A
  • FVC
  • FEV1
  • FEV 1%
336
Q

When the patient has a normal hemoglobin concentration, pulmonary capillary blood volume, and ventilatory status, the only limiting factor to the diffusion of carbon monoxide is the _____________.

A

Alveolar-capillary membrane

337
Q

Graphic representation of both a forced vital capacity maneuver and a forced inspiratory volume (FIV) maneuver.

A

Flow-volume loop

338
Q

What measurements are increased in a restrictive lung disorder?

A
  • FEV1/FVC (Normal or increased)
  • FEV 1% (Normal or increased)
339
Q

What measurements are decreased in a restrictive lung disorder?

And what’s normal?

A

Volumes
- VT (Normal or decreased)
- IRV
- ERV
- RV
- MVV (Normal or decreased)
- FEF 25%-75% (Normal or decreased)
- FEF 50% (Normal or decreased)
- FEV1/FVC
- PEFR (Normal or decreased)
- FEF 200-1200 (Normal or decreased)
- FEVT (Normal or decreased)
Capacities
- VC
- IC
- TLC
- FRC
- FVC

NORMAL: RV/TLC

340
Q

What measurements are decreased in a obstructive lung disorder?

A

Volumes
- IRV (Normal or decreased)
- ERV (Normal or decreased)
- MVV

Capacities
- IC (Normal or decreased)
- VC
- FVC
- FEF 50%
- FEVT
- FEF 200-1200
- PEFR
- FEV/FVC
- FEF 25-75%

341
Q

What measurements are increased in a obstructive lung disorder?

A

Volumes
- VT (Normal or increased)
- RV/TLC ratio (Normal or increased)
- RV

Capacities
- FRC
- TLC (Normal or increased)

342
Q

What is used to evaluate the status of medium to small airways in obstructive lung disorders?

A

FEF 25%-75%

4.5 L/s (270L/min)

343
Q

Normal FEF 200-1200 value for the average healthy man

A

8 L/s (480 L/min)

344
Q

_______ provides a good assessment of the large upper airways.

A

Peak Expiratory Flow Rate

345
Q

PEFR can be measure easily with what?

A

At the patient’s bedside with a hand-held peak flowmeter

346
Q

________ is the average flow rate generated by the patient during the middle 50% of an FVC measurement.

A

FEF 25-75%

4.5L/s (270 L/min)

347
Q

What measures the average flow rate between 200 and 1200 mL of an FVC.

A

Forced Expiratory Flow 200-1200

348
Q

What does MIP primarily measure?

A

Inspiratory muscle strength — that is, the power of the diaphragm and external intercostal muscles

349
Q

An MIP of -25 cmH2o or less (more negative) usually indicates _____________________.

A

Adequate muscle strength to maintain spontaneous breathing

350
Q

What does MEP primarily measure?

A

Strength of the abdominal muscles — that is, the rectus abdominis muscles, external abdominis oblique muscles and internal abdominis oblique muscles, transversus abdominis muscles and internal intercostal muscles

351
Q

The adult MEP is greater than ______ in males and greater than ______ in females

A

Males - 100 cm H2O
Females - 80 cm H2O

352
Q

Where are unsatisfactory MEP values commonly seen?

A
  • Patients with neuromuscular disease
  • High cervical spine fractures
  • COPD
353
Q

________ involves treadmill or victor ergometer testing while a variety of physiologic parameters are measured and/or calculated.

A

Cardiopulmonary Exercise Test (CPET)

354
Q

What are some useful ways of confirming diagnosis of asthma?

A
  • Inhaled methacholine or histamine
  • Indirect challenge test to inhaled mannitol
  • Exercise or cold air challenge
355
Q

Inhalation challenge tests can be performed only when the patient has a FEV1 of ___________, to avoid inducing asthma symptoms in an already compromised patient.

A

80% or greater

356
Q

Impulse oscillometry is used to assess ______________________.

A
  • Large and small airway obstructions
  • Bronchodilator response
  • Bronchoprovocation tesing
357
Q

IOS can be performed in patients on ventilators and during sleep. T or F?

A

True

358
Q

What are the two ways oxygen is carried in the blood?

A
  1. Dissolved oxygen in the blood plasma
  2. Oxygen bound to hemoglobin
359
Q

In the healthy individual, over ________ of the oxygen that diffuses into the pulmonary capillary blood chemically combines with hemoglobin.

A

98 percent

360
Q

What is the normal hemoglobin value for men?

A

14-16 g/dL

361
Q

What is the normal hemoglobin value for women?

A

12-15 g/dL

362
Q

Each gram of hemoglobin is capable of carrying about _______ of oxygen.

A

1.34 mL

363
Q

Define (P[A-a]O2).

A

The oxygen tension difference between the alveoli and arterial blood.

Also known as the alveolar-arterial tension gradient.

364
Q

_____________ is an S-shaped curve on a nonogram that illustrates the percentage of hemoglobin that is saturated with oxygen related to oxygen at a specific oxygen partial pressure.

A

Oxyhemoglobin dissociation curve, also called oxyhemoglobin equilibrium curve

365
Q

a PO2 increase from 60 to 100 mm Hg only increases the total saturation of hemoglobin by ____.

A

7 percent

366
Q

_________ is the ratio of carbon dioxide production divided by oxygen consumption.

A

RQ, the respiratory quotient

367
Q

Under normal circumstances, about ______ of oxygen per minute is consumed by tissue cells.

A

250 mL

368
Q

Under normal circumstances, about _____ of carbon dioxide is excreted in the lung per minute.

A

200

369
Q

The normal P(A-a)O2 on room air at sea level ranges from _______ and should not exceed 30 mm Hg.

A

7-15 mm Hg

370
Q

The normal value for P(A-a) O2 on 100% oxygen is between _____________.
What is the critical value?

A

25 and 65 mm Hg.
The critical value is greater than 350 mm Hg

371
Q

P(A-a) O2 is normal when __________ is the cause of patient’s hypoxemia.

A

Alveolar hyperventilation

372
Q

P(A-a) O2 increases in response to -

A
  • Oxygen diffusion disorders
  • Ventilation perfusion mismatching
  • Right-to-left intracardiac shunting
  • Age
373
Q

What reflects the amount of alveolar oxygen that moves into the arterial blood?

A

PaO2/PAO2 ratio

374
Q

What is the normal range for arterial-alveolar pressure ratio, for a young adult?

A

0.75 and 0.95

The critical value is less than 0.75

375
Q

When is PaO2/PAO2 most reliable?

A
  • When ratio is less than 0.55
  • FiO2 greater than 0.30
  • PaO2 less than 100 mm Hg
376
Q

What is useful in determining the extent of lung diffusion defects?

A

PaO2/FiO2 ratio

377
Q

___________ is the amount of oxygen delivered to the peripheral tissue cells

A

Total oxygen delivery (DO2)

378
Q

__________ is the amount of oxygen consumed by the tissue cells divided by the total amount of oxygen delivered.

A

Oxygen extraction ratio

379
Q

Normally, the oxygen consumption (VO2) is about _________ of oxygen per minute.

A

250 mL

380
Q

Normally, the SVO2 (mixed venous oxygen saturation) is about _______.

A

75%

381
Q

What type of hypoxia is this?
Inadequate oxygen at the tissue cell caused by low arterial oxygen tension (PaO2)

A

Hypoxic hypoxia

381
Q

What type of hypoxia is this?
PaO2 is normal, but the oxygen-carrying capacity and thus the oxygen content of the blood is inadequate

A

Anemic hypoxia

382
Q

What type of hypoxia is this?
Impaired ability of the tissue cells to metabolize oxygen

A

Histotoxic hypoxia

383
Q

What type of hypoxia is this?
Blood flow to the tissue cells is inadequate; therefore adequate oxygen is not available to meet tissue needs

A

Circulatory hypoxia, also called stagnant or hypoperfusion hypoxia

384
Q

An increased level of red blood cells is called ______________.

A

Polycythemia

385
Q

What is defined as an inadequate level of tissue oxygenation?

A

Hypoxia

386
Q

What is useful in assessing the patient’s cardiopulmonary status?

A

Arterial-venous oxygen content difference

(C[a-v]O2)

387
Q

__________ is a good indicator of the patient’s oxygenation status

A

Arterial oxygen tension - PaO2

388
Q

Normally, the DO2 is about ______ of oxygen per minute.

A

1000 mL

389
Q

Normally, the VO2 (oxygen consumption) is about _________ of oxygen per minute.

A

250 mL

390
Q

What is defined as an abnormally low arterial oxygen tension?

A

Hypoxemia

391
Q

Hypoxia is characterized by:

A
  • Tachycardia
  • Hypertension
  • Peripheral vasoconstriction
  • Dizziness
  • Mental confusion
392
Q

Normally, the C(a-v)O2 is about _______.

A

5 mL/dL

393
Q

______ is a term used to denote pulmonary arterial hypertension, right ventricular hypertrophy, increased right ventricular work and ultimately right ventricular failure.

A

Cor polmonale

394
Q

When hypoxia exists, alternative anaerobic mechanisms are activated in the tissues that produce dangerous metabolites like _________.

A

Lactic acid

395
Q

Clinically, the presence of mild hypoxemia generally stimulated the oxygen peripheral chemoreceptors to ____________.

A

Increase the patient’s breathing rate and heart rate

396
Q

Red blood cell production is known as what?

A

Erythropoiesis

397
Q

When pulmonary disorders produce chronic hypoxia, the renal cells release higher than normal amounts of the hormone erythropoietin which in turn stimulates __________.

A

The bone marrow to increase red blood cell production

398
Q

At normal body temperature about _____ of oxygen will dissolve in each 100 mL of blood for every 1 mm Hg of PO2.

A

0.003 mL

399
Q

Decrease DLCO is a hallmark clinical manifestation in ___________.

A

Emphysema

RET1293 (10 decks)

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