COW

Question 1

What 2 tests do you want to get if you have a patient with breathing problems?

Answer 1

x-ray and ABG

Question 2

What does ABG give you?

Answer 2

gives you Po2 (to see if they are oxygenated) and PCO2 (tells about ventilation)

Question 3

What does the alveolar gas equation do for us?

Answer 3

gives you alveolus partial pressure of O2 (PAO2);

this allows us to compare it to arterial O2 to determine if you have approriate A-a gradient

Question 4

What is a normal A-a gradient?

Answer 4

5-10

Question 5

If you have a normal A-a gradient but the patient is still hypoxemic, what does this tell you?

Answer 5

You do not have diffusion issues, you have ventilatory failure.

Question 6

What are common causes of ventilatory failure?

Answer 6

hypoventilation-> drug overdose (narcotics, alcohol),

disruption of chest wall mechanics (neurologic muscular dieases), muscular dystrophies,

Question 7

If Co2 elevates what happens?

Answer 7

pH drops, then body tries to fix this via the kidneys and bicarbonates.

Question 8

So if you see someone with elevated pCO2 and you have low pH then that is (blank). If you see someone come in with a normal pH and an elevated pCO2 of 60 means that this is (blank)

Answer 8

acute

chronic (they had a few days to buffer this)

Question 9

What is the most important treatment to initiate with a person with respiratory issues?

Answer 9

GIVE O2!!!

Question 10

If you give someone lots of oxygen who has hypoxemia, you may eliminate their drive to breath,which will cause them to hypoventilate more and then their (blank) will go up. How do you fix this?

Answer 10

pCO2

decrease their amount of oxygen to about 90-92%

Question 11

What is more important, making sure a person doesnt have too much CO2 or making sure a person has enough oxygen?

Answer 11

never ever sacrifice oxygen for Co2,never let a patient be hypoxemic due to the possibility of making the patient hypoventilate. So how do you keep them from hypoventilating if you dont want them to be hypoxic? ventilate them!

Question 12

What do you need to diagnosis pulmonary obstruction diseases?

Answer 12

pulmonary function tests (effort dependent)

Question 13

If a patient has acute exasperation (respiratory distress), can you get a pulmonary function test? Can you do a Peak Flow?

Answer 13

no because this test is effort based

yes

Question 14

What are the three most significant numbers in spirometry?

Answer 14

Forced vital capacity, max inspiration, max expiration

Question 15

If you have a normal forced vital capacity what will it look like on a graph?
What if you have pulmonary obstruction?
What if you have restrictive lung disease (not problem with airflow with airways)?
What if you have a variable extrathoracic obstruction?
What if you have poor effort?

Answer 15

it will rise steeply and have a high expiratory flow rate and then decrease linearly (has large FVC)
It will have a reduced expiratory flow rate and then decrease linearly with a very reduced FVC
Maintained peak expiatory flow rate but very reduced FVC (more reduced than PO)
Maintain your FVC, flate expiratory flow rate and a very reduced peak expiratory flow rate.
you will have an arch, no steep incline like all the other.

Question 16

If you have a FEV1/FVC ratio is less than (blank) you have pulmonary obstruction

Answer 16

70%

Question 17

If you have a normal inspiration but an abnormal expiratory flow rate (flat) where will your problem be located?

Answer 17

intrathoracic obstruction (typically in the trachea!!!!!!)  
e.g cancer in the trachea

Question 18

When looking at a chest x-ray with COPD, what can you notice?

Answer 18

very low and flat diaphragm,

Question 19

How can you tell if a heart is enlarged?

Answer 19

it should be less than the size of half the chest

Question 20

If you come to hospital with pneumonia and get a CT will it always show it?

Answer 20

no, typically they show it after people get worse.CT’s typically have a delay

Question 21

If a patient is always hypoxic, should they always be on oxygen?

Answer 21

yes! (makes them live longer)

Question 22

Are bronchodilators and steroids necessary?

Answer 22

yes (typically don’t give oral steroids)

Question 23

COPD is a chronic disease, once you have it,it never goes away and it progresses, what slows down this progression?

Answer 23

quitting smoking

Question 24

What does this person have?

• mild dyspnea on exertion for several years but recently has experienced worsening SOB with minimal exertion and even sometimes at rest. -
• cough with production of yellowish sputum and sputum became green.
• smokes
• Soft left cervical bruit.
• He is using accessory respiratory muscles.
• The anterior-posterior diameter of the chest wall appears increased.
• Wheezes and rhonchi are audible bilaterally but no rales.
• high respiratory rate
• high BP
• PaO2 is low
• PCO2 is high
• high hematocrit

Answer 24

COPD