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Respiratory > Chapter 3 MDT > Flashcards

Chapter 3 MDT Flashcards

1
Q

Episodic or chronic symptoms of wheezing, dyspnea, or cough

Symptoms frequently worse at night or early morning

Prolonged expiration and diffuse wheezes on physical exam

A

Asthma

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2
Q

Chronic disorder of the airways characterized by variable airway obstruction, airway hyperresponsiveness, and airway inflammation

A

Asthma

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3
Q

Plays a central role in the pathogenesis of allergic asthma

A

IgE

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4
Q

Important in promoting eosinophilic inflammation

A

Interleukin-5

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5
Q

Most common type of asthma, usually begins in childhood and is associated with other allergic diseases such as eczema, allergic rhinitis, or food allergy.

A

Allergic asthma

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6
Q

Late asthmatic response

A

Symptoms 4-6 hours after allergen exposure

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7
Q

Selected individuals may experience asthma symptoms after exposure to aspirin

A

Aspirin-exacerbated respiratory disease

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8
Q

Triggered by various agents in the workplace and may occur weeks to years after initial exposure and sensitization

A

Occupational asthma

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9
Q

Women may experience asthma symptoms at predictable times during their menstrual cycle

A

Catamenial asthma

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10
Q

Begins during exercise or within 3 minutes after its end, peaks within 10-15 minutes, and then resolves by 60 minutes

A

Exercise-induced bronchoconstriction

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11
Q

This phenomenon is thought to be a consequence of the airways’ warming and humidifying an increased volume of expired air during exercise

A

Exercise-induced bronchoconstriction

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12
Q

Wheezing precipitated by pulmonary edema in the setting of decompensated heart failure

A

Cardiac asthma

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13
Q

Cough instead of wheezing as the predominant symptom of bronchial hyperreactivity

A

Cough-variant asthma

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14
Q

Signs and symptoms:

Episodic wheezing, shortness of breath, chest tightness, and cough.
Symptoms vary over time and in intensity and are often worse at night or early in the morning.

A

Asthma

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15
Q

Physical findings found in patients with allergic asthma

A

Mucosal swelling, increased secretions, polyps, eczema, atopic dermatitis, or other skin disorders

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16
Q

Asthma patient:

Arterial blood gas may be normal, but what lab will show an increased result?

A

Respiratory alkalosis and alveolar-arterial oxygen difference

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17
Q

Asthma:

The combination of an increased PaCO2 and respiratory acidosis may indicate:

A

Impending respiratory failure and the need for mechanical ventilation

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18
Q

Asthma:

Test used before and after administration of a bronchodilator

A

Spirometry

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19
Q

1) Assessing asthma control and severity
2) Distinguishing between severe and uncontrolled asthma
3) Personalized pharmacologic therapy for asthma
4) Treatment of modifiable risk factors and control of environmental factors
5) Guided self-management education and skills training

A

Five important aspect of chronic asthma management; from the Global Strategy for Asthma Management and Prevention

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20
Q

Asthma:

Medication therapy reserved for patients who are acutely ill and those who cannot use inhalers because of difficulties with coordination, understanding, or cooperation.

A

Nebulizer therapy

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21
Q

Most effective bronchodilator during exacerbations and provide immediate relief of symptoms

A

SABAs

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22
Q

Most effective in achieving prompt control of asthma during acute exacerbations

A

Systemic corticosteroids

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23
Q

Asthma medication:

Reverse vagally mediated bronchospasm but not allergen or exercise-induced bronchospasm

A

Anticholinergics

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24
Q

Potent mediators that contribute to airway obstruction and asthma symptoms by contracting airway smooth muscle, increasing vascular permeability and mucous secretion, and attracting and activating airway inflammatory cells

A

Leukotriene modifiers

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25
Q

Provides mild bronchodilation in asthmatic patients. It also has anti-inflammatory and immunomodulatory properties, enhances mucociliary clearance, and strengthens diaphragmatic contractility

A

Phosphodiesterase inhibitor (Theophylline)

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26
Q

Long-term control medications that prevent asthma symptoms and improve airway function in patients with mild persistent or exercise-induced asthma

A

Mediatory inhibitors (Cromolyn sodium and Nedocromil)

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27
Q

Patients who require monoclonal antibody therapies should be evaluated by a:

A

Pulmonologist or allergist experienced in their use

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28
Q

Vaccines:

Adult patients aged 19-64 with asthma should receive the:

A

23-valent pneumococcal polysaccharide vaccine (Pneumovax 23)

Annual Influenza

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29
Q

Common cause of asthma deaths

A

Asphyxia

administer oxygen immediately

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30
Q

When would you refer an asthmatic patient:

After how many courses of oral prednisone therapy in the past 12 months?

A

More than 2 courses of oral prednisolone

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31
Q

Sudden onset of asthma-like symptoms following high-level exposure to a corrosive gas, vapor, or fumes

A

Reactive airway dysfunction syndrome (RADS)

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32
Q

Symptoms:

  • Acute single event with exposure to a chemical/irritant
  • Mucus membrane irritation of the upper airway
  • Dyspnea
  • Cough
  • Possible wheezing
  • Possible hypoxia
A

Reactive airway dysfunction syndrome (RADS)

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33
Q

RADS is less responsive to:

A

Beta2 Agonists

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34
Q

Hallmark signs:

Acute exacerbation of symptoms beyond day-to-day variation including increased dyspnea, increased frequency or severity of cough, increased sputum volume or character

A

COPD

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35
Q

Emphysema

Chronic bronchitis

Chronic obstructive asthma

A

COPD Subtypes

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36
Q

Airflow limitation that is not reversible

A

COPD

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37
Q

Usually presents in the 5th or 6th decade of life with symptoms often present for 10 years

A

COPD

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38
Q

Abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles that is accompanied by destruction of the airspace walls, without obvious fibrosis

A

Emphysema

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39
Q

Physical exam:

Over distention of the lungs in the stable state, decreased intensity of breath and heart sounds, and prolonged expiratory phase

A

Emphysema

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40
Q

“Pink Puffer”

A

Emphysema predominant

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41
Q

“Blue Bloater”

A

Bronchitis predominant

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42
Q

Chronic productive cough for three months in each of two successive years in a patient and other causes of chronic cough have been excluded

A

Chronic bronchitis

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43
Q

Major complaint of dyspnea

Usually presents after age 50

Cough is rare

Patients are thin

Accessory muscle use

Chest is quiet without adventitious lung sounds

A

Emphysema

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44
Q

Major complaint is productive cough with mucopurulent sputum

Frequent exacerbations due to chest infections

Often present in their 30’s and 40’s

Mild dyspnea

A

Chronic bronchitis

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45
Q

How many times will you test peak expiratory flow rate?

A

Three times total

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46
Q

Imaging:

Identifies and can quantify the emphysema phenotype associated with loss of tissue, can detect airway narrowing and wall thickening characteristic of a bronchitis phenotype

A

CT

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47
Q

Predisposition to venous thrombosis, especially in the legs

Acute onset of dyspnea, pleuritic chest pain, tachypnea, and tachycardia

Elevated rapid D-dimer, characteristic defects on imaging

A

Pulmonary embolism

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48
Q

Air embolization occurs most commonly after:

A

Penetrating trauma

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49
Q

Clots that form pulmonary emboli are most commonly from the:

A

Femoral or pelvic venous beds

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50
Q

Patients with DVT are how likely to develop PE?

A

50-60%

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51
Q

Venous Stasis

Injury to the vessel wall

Hypercoagulability

A

Virchow’s Triad (PE/DVT)

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52
Q

Massive embolization causes:

A

Acute pulmonary hypertension

Right Heart Strain

Systemic hypotension

Shock

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53
Q

Standard for PE diagnosis

A

Pulmonary Angiography

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54
Q

Fever, cough, along with other symptoms of the lower respiratory tract

Smoking history

Nasopharyngeal or GI Bleed

A

Hemoptysis

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55
Q

Expectoration of blood can range from blood-streaking of sputum to the presence of gross blood from below the vocal cords or within the lungs.

A

Hemoptysis

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56
Q

> 500 mL of expectorated blood over a 24-hour period or bleeding at a rate of >100 mL/hour

A

Massive hemoptysis

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57
Q

Hemoptysis patient, evaluate for:

A

Tachycardia

Hypotension

Decreased oxygen saturation

Inspect nose and oropharynx

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58
Q

How would you assess the bleeding magnitude in a hemoptysis patient?

A

Hemoglobin and hematocrit levels, white blood cell count and differential for possible infection

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59
Q

Most important study for hemoptysis patients

A

Chest CT

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60
Q

Treatment for Hemoptysis

A

Position the patient - good lung on top

Establish a patent airway

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61
Q

Clear rhinorrhea, hyposmia, and nasal congestion

Malaise, headache, and cough

Erythematous, engorged nasal mucosa on exam

Symptoms last less than 4 weeks and typically less than 10 days

A

Upper respiratory infection

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62
Q

Most frequent acute illness

A

Upper respiratory infection

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63
Q

Refers to a mild upper respiratory viral infection involving, to variable degrees, nasal congestion and discharge, sneezing, sore throat, cough, low grade fever, headache, and malaise

A

“Common Cold”

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64
Q

Colds typically last longer in what kinds of patients?

A

Smokers

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65
Q

Most common and characteristic initial symptoms are nasal discharge, nasal obstruction, and a dry or “scratchy throat”. Cough is common and tends to appear after the onset of nasal discharge and obstruction.

A

Upper respiratory infection

66
Q

Incubation period for most common cold viruses

A

24-72 hours

67
Q

Colds usually persist for how many days in the normal host?

A

3-10 days

68
Q

Cough associated with midline burning chest pain, fever, and dyspnea

A

Bronchitis

69
Q

Primary clinical difference between bronchitis and pneumonia is the presence of:

A

Infiltrate on the chest X-ray for pneumonia

70
Q

Excessive production of bronchial mucous and daily productive cough for 3 months in the past 2 years

A

Chronic bronchitis

71
Q

Disposition for a patient diagnosed with bronchitis

A

Modified duty. 1-2 days SIQ.

72
Q

Antibiotics are not typically recommended for bronchitis, unless the course is prolonged because:

A

Primary cause is viral etiology

73
Q

Fever or hypothermia, cough with or without sputum, dyspnea, chest discomfort, sweats, or rigors

Bronchial breath sounds of rales

Parenchymal infiltrate on chest X-ray

A

Pneumonia

74
Q

Development of lower respiratory tract infections occurs from:

A

Aspiration of secretions containing bacteria

Inhalation of infected aerosols

75
Q

Cough reflex

Mucociliary clearance system

Immune responses

A

Pulmonary defense mechanisms

76
Q

Prospective studies have failed to identify the cause of community-acquired pneumonia in what percent of cases?

A

40-60%

77
Q

Pneumonia will have two causes in what percentage of cases?

A

5%

78
Q

Most common bacterial pathogen identified in most studies of community-acquired pneumonia, accounts for 2/3’s of bacterial isolates.

A

Streptococcus pneumonia

79
Q

Constitutional symptoms

Cough with foul-smelling purulent sputum

Dentition is often poor

A

Aspiration Pneumonia or lung abscess

80
Q

Periodontal disease and poor dental hygiene are associated with a greater likelihood of:

A

Anaerobic pleuropulmonary infection

81
Q

Clearing of pulmonary infiltrates in patients with community-acquired pneumonia can take:

A

6 weeks or longer

82
Q

Patients with anaerobic pleuropulmonary infection usually present with:

A

Constitutional symptoms

Cough with foul odor expectorant

Poor Dentition

83
Q

Expect a bronchial lesion if:

A

Patient is missing teeth

84
Q

Aspiration pneumonia usually effects what lung zones:

A

1) Posterior segments of upper lobes
2) Superior and basilar segments of the lower lobes
3) Body position at the time of aspiration

85
Q

Decreased breath sounds, dullness to percussion on affected side. Respiratory distress and hypotension.

A

Hemothorax

86
Q

Most commonly is a secondary injury to penetrating trauma

A

Hemothorax

87
Q

Physical findings:
-Respiratory distress, tachypnea, variable degrees of hypoxia

  • Dullness to percussion, decreased breath sounds
  • Hypotension, pulse pressure narrow
A

Hemothorax

88
Q

What position would make a smaller hemothorax difficult to detect in patients?

A

Supine

89
Q

What volumes of a hemothorax can be seen in chest X-rays?

A

200-300mL

90
Q

Treatment for a hemothorax:

A

Intact airway

Oxygen

Tube thoracotomy

91
Q

Absent or decreased breath sounds. Hyper resonance to percussion on affected side.

A

Pneumothorax

92
Q

Abnormal collection of air within the pleural space

A

Pneumothorax

93
Q

Pneumothorax can be classified as:

A

Spontaneous or traumatic

94
Q

Spontaneous pneumothorax occurs in what types of patients?

A

Young, tall, men age 20-40.

Occurs from a rupture of subapical blebs.

95
Q

Invasive procedures that cause traumatic pneumothorax

A

Subclavian line placement

Thoracentesis

Lung or pleural biopsies

Barotrauma from positive pressure ventilation

96
Q

Physical findings:

  • Pleuritic chest pain, tachypnea, tachycardia
  • Chest pain ranging from minimal to severe and dyspnea
  • Diminished breath sounds, decreased tactile fremitus, decreased chest movement, hyper resonance on affect side
A

Pneumothorax

97
Q

What imaging would reveal most pneumothoraxes?

A

Chest X-ray

98
Q

For stable pneumothorax patients, when would you want to get a second chest X-ray to compare?

A

3-6 hours

99
Q

Tracheal deviation from the opposite side with absent lung sounds. Patient is in respiratory distress and hypotension.

A

Tension pneumothorax

100
Q

One-way valve air leak occurs from either the lung or the chest wall

Air enters the pleural space but cannot escape

A

Tension Pneumothorax

101
Q

Physical findings:

  • Respiratory distress, tachypnea, tachycardia
  • Hyper resonance to percussion
  • Decreased or absent breath sounds to auscultation
  • Trachea deviated
  • Neck veins distended
A

Tension Pneumothorax

102
Q

Where would you insert a needle thoracentesis?

A

Large bore 16g or larger IV catheter, Second intercostal space at the mid clavicular line

103
Q

Risk recurrence of tension pneumothorax

A

50%

104
Q

Daytime somnolence

History of loud snoring with witnessed apneic events

Overnight polysomnography demonstrating apneic episodes with hypoxemia

A

Chronic Obstructive Sleep Apnea

105
Q

Clinical risk factors for Chronic Obstructive Sleep Apnea

A

Advancing age

Male Gender

Obesity

106
Q

What acronym is used to diagnose Sleep Apnea?

A

STOP BANG

107
Q

How many questions on the STOP BANG questionnaire need to be answered “YES” for high risk of sleep apnea?

A

3 or more

108
Q

Sudden onset of intermittent (fleeting) pain in the chest wall

Usually follows an injury or illness

Pain worsened by coughing, sneezing, deep breathing or movement

A

Pleuritis

109
Q

Inflammation of the pleura

A

Pleuritis

110
Q

In young healthy patients, pleuritis is usually caused by:

A

Viral respiratory illness or Pneumonia

111
Q

Pleuritic chest pain may lead to:

A

Splinting and atelectasis significant enough to produce hypoxemia

112
Q

Physical findings:

  • Dyspnea
  • Pain is usually localized, sharp, and fleeting
  • Pain is worse by coughing, moving, and breathing
  • Friction rub
  • Ipsilateral shoulder pain
A

Pleuritis

113
Q

When would you get a Chest X-ray in a patient with pleuritis?

A

To rule out lung disease, pleural effusion, or pneumothorax

114
Q

Most common injury sustained in blunt thoracic trauma

A

Rib fractures

115
Q

What rib fracture would indicate severe trauma because of the necessary force to produce such an injury

A

First rib

116
Q

What percentage of rib fractures can not be detected in a Chest X-ray?

A

50%

117
Q

What allows for healing of the ribs and prevention of complications in the patient with respiratory failure?

A

Mechanical Ventilation

118
Q

Rib fracture patient:

Promotes redistribution of ventilation and perfusion to various lung segments

A

Continuous body positioning and oscillation therapy

119
Q

Mainstay treatment for a patient with multiple rib fractures

A

Rapid mobilization, respiratory support, and pain management

120
Q

Disposition of young, healthy patients with isolated rib fractures without evidence of serious underlying injuries

A

Pain medication

Deep breathing exercises

Incentive spirometry

121
Q

Segment of the chest does not have bony contiguity with the rest of the thoracic cage

A

Flail chest

122
Q

Physical findings:

  • Pain and respiratory distress
  • Tachypnea with shallow respirations secondary to pain
  • Crepitus
A

Flail Chest

123
Q

Treatment of flail chest

A

Oxygen

Pain control with opioids

Consider early intubation and mechanical ventilation

124
Q
  • Fatigue, weight loss, fever, night sweats, productive
  • Cough >2 to 3 weeks duration, lymphadenopathy
  • Chest X-ray: Pulmonary opacities
  • Sputum culture positive
A

Tuberculosis

125
Q

Major site for Mycobacterium tuberculosis

A

Lungs

126
Q

Physical findings:

  • Dullness with decreased fremitus
  • Crackles or posttussive crackles
  • Amphoric breath sounds
  • Whisper Pectoriloquy may be heard
  • Clubbing
A

Tuberculosis

127
Q

Lab test for TB

A

Acid fast bacilli light microscope (3 consecutive morning specimens)

128
Q

Percentage of patients with reactive TB involving the apical-posterior segments of the upper lobes

A

80-90%

129
Q

Regimen for pulmonary tuberculosis

A

2-month phase of a 4-drug regimen
Followed by:
4-7 months of rifampin and isoniazid

130
Q

Regimen for tuberculous meningitis

A

2-month phase of a 4-drug regimen
Followed by:
7-10 months of Rifampin and Isoniazid

Tapered 6-8 weeks of corticosteroid therapy

131
Q

Injuries of the lung parenchyma with hemorrhage and edema without associated laceration

Occur in 30-75% of patients with significant blunt chest trauma

Often associated with thoracic injuries such as rib fractures and flail chest

A

Pulmonary contusion

132
Q

Most frequent intrathoracic injuries in nonpenetrating chest trauma

A

Pulmonary Contusion

133
Q

Most common complication of pulmonary contusion

A

Pneumonia

134
Q

Physical Findings:

  • Silent during initial trauma evaluation
  • Traumatic mechanism and presence of other associated thoracic injuries
  • Hypoxia
A

Pulmonary contusion

135
Q

When is radiographic evidence of a pulmonary contusion usually apparent?

A

6 hours after injury

136
Q

Mainstay treatment for pulmonary contusion:

A
  • Oxygen
  • IV Fluids
  • Chest physiotherapy
137
Q

Severe pulmonary contusion therapy

A

Mechanical ventilation with positive end-expiratory pressure

138
Q

Percentage of tracheobronchial injuries that die before reaching the hospital

A

80%

139
Q

Common clinical symptoms and signs suggestive of injury to the trachea or bronchus are:

A
  • Dyspnea
  • Subcutaneous emphysema of the neck or upper thoracic region
  • Hoarseness
  • Hemoptysis
  • Hypoxia
  • Persistent pneumothorax despite appropriate tube thoracotomy
140
Q

CXR findings indicative of tracheobronchial injury:

A

Subcutaneous emphysema

Pneumomediastinum

Pneumothorax

Peri-bronchial air

141
Q

Treatment for tracheobronchial injury patients that are in respiratory distress:

A

Endotracheal Intubation

142
Q

Why would you want to avoid blind intubation on a tracheobronchial injured patient?

A

May result in the complete disruption of small tracheal lacerations

143
Q

Treatment for stable tracheobronchial injury patients:

A

Immediate bronchoscopy

-Localize the injury and surgically repair

144
Q

Severe airway obstruction

Immediately life threatening and must be relieved promptly to avoid asphyxia

A

Acute Respiratory Distress Syndrome (ARDS)

145
Q
  • Trauma to the larynx
  • Foreign body aspiration
  • Laryngospasm
  • Laryngeal edema from burns
  • Infections
  • Acute allergic laryngitis

Can cause what?

A

Acute Respiratory Distress Syndrome (ARDS)

146
Q

What has reduced the number of ARDS deaths?

A

Heimlich maneuver

147
Q

Physical findings:

  • Stridor respirations
  • Retractions of muscles
  • Can’t talk or breathe
  • May have visible swelling
A

Acute Respiratory Distress Syndrome (ARDS)

148
Q

Principal benefits of mechanical ventilation during respiratory failure:

A

Improved Gas Exchange

Decreased work of breathing

149
Q

Amount of pressure that will keep alveoli open during expiration. Normal setting is between 5-10cm H2O.

A

Positive End Expiratory Pressure (PEEP)

150
Q

Amount of oxygen you are delivering to the patient with normal amount being between 21-100%.

A

Fraction of inspired oxygen (FIO2)

151
Q

Ventilation is the control of the amount of _________ in the body

A

Carbon Dioxide

152
Q

Buildup of CO2 which leads to more acid building up in the blood

A

Respiratory Acidosis

153
Q

Ventilator:

What controls the amount of oxygen in the blood?

A

FIO2 & PEEP

154
Q

Ventilator:

This mode of ventilation that can do all the breathing for the patient.

A

Volume Control Ventilation (VC)

155
Q

You want the Peak Inspiratory Pressure (PIP) to be below what number to avoid alveolar trauma?

A

40 cm H2O

156
Q

This mode of ventilation that is only set if the patient is breathing on their own, but need extra support, or you do not have enough sedation to totally sedate them

A

Continuous Positive Airway Pressure (CPAP)

157
Q

Amount of extra pressure the ventilator delivers on inspiration when the patient triggers a breath

A

Pressure Support (PS)

158
Q

Ventilator:

Goal to keep CO2 at:

A

35-45 mmHg

159
Q

Blood pH should be between:

A

7.35 to 7.45

160
Q

Confirm ET tube is in trachea by using:

A

End-Tidal CO2

161
Q

Ventilator:

Recommended frequency for cleaning the mouth out with chlorhexidine:

A

Every 4 hours

162
Q

Acute onset or worsening of dyspnea at rest

Tachycardia, diaphoresis, cyanosis

Pulmonary rales, rhonchi; expiratory wheezing

X-rays show interstitial and alveolar edema with or without cardiomegaly

Arterial hypoxemia

A

Pulmonary Edema

Respiratory (5 decks)

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