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Final Exam Flashcards

1
Q

What clinical condition could cause Respiratory Acidosis with mild hypoxia
A. Hypoventilation due to post op sedation
B. Asthma
C. Pulmonary Emboli
D. Nasogastric suction

A

A.

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2
Q 
Clinical condition with Comp. Resp. Acidosis with mod. hypoxia
A. Pulm Emboli
B. Status asthmaticus
C. Ketoacidosis
D. Emphysema
A

B

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3
Q 
Clinical condition with Resp Alkalosis with mod. hypoxia
A. Chronic Bronchitis
B. Pulmonary Emboli
C. Asthma
D. Pain
A

B

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4
Q

Diabetic Ketoacidosis ABG

A

Comp metabolic acidosis

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5
Q

Cardiac/ resp arrest ABG

A

Combined acidosis with severe hypoxia

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6
Q 
What are the three main factors that contribute to airway obstruction in asthma
I. Inflammation
II. Ciliary Dysfuntion
III. Mucus accumulation
IV. Bronchospasm
V.
A

B. I, III, IV

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7
Q

Asthma is a what disease

A

obstructive

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8
Q

During an extrinsic induced asthma episode, sputum tends to be

A

thick, whitish, tenacious

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9
Q

A common tool for home use to assess the severity of bronchospasm associated with asthma is

A

peak flow meter

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10
Q

Zone system based on peak flow measurements

A

Green Zone- 80% or greater
Yellow Zone- 50-80%
Red Zone- 50%

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11
Q 
What med group is commonly administered to pts with interstitial lung disease
A. Antibiotics
B. Mucolytics
C. Corticosteroids
D. Long acting bronchodilators
A

C. Corticosteroids

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12
Q 
Your pt with a mild to moderate interstitial lung disease, has hypoxemia and will be given O2 therapy. All the following are possible cause of hypoxemia except:
A. Hypoventilation
B. Capillary shunting
C. Alveolar thickening 
D. Fibrosis
A

B. Capillary shunting

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13
Q

While assessing a pt who was involved in a serious car crash and hit his steeling wheel you notice that his left anterior chest wall caves in during inspiration. Cause?

A

Flail chest segment

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14
Q 
Benign tumors
I. Are metastatic
II. Grow slowly
III. Are usually Encapsulated
IV. Grow in a disordered manner
A

II and III only

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15
Q

What are the anatomic alternations that occur when a person has a pneumothorax
I. The lung on the affected side collapses
II. Visceral and parietal pleura separate
III. The visceral pleura adheres to the parietal pleura
IV. Chest wall moves outward

A

I, II, and IV

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16
Q 
Malignant tumors
I. Invade surrounding tissues
II. Grow slowly
III. Cause Necrosis
IV. push aside surrounding tissue
A

I and III only

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17
Q

When a person has lung cancer all of the following may happen to the alveoli adjacent to the tumor

A

Collapse, Consolidation, Filling with fluid

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18
Q

Flail chest is defined as

A

Three or more adjacent fractured ribs, Double fracture of each rib

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19
Q

Posterior curvature of the spine best describes

A

kyphosis

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20
Q

Your patient has a large pleural effusion. It will act as a/an

A

Restrictive disorder

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21
Q

If mech vent is required, how long will it be needed to allow sufficient time for the ribs of a flail chest to heal

A

5-10 days

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22
Q 
The major pathologic and structural changes associated with a significant pleural effusion include all of the following except
A. Diaphragm elevation
B. Atelectasis
C. COmpression of the greater vessels
D> Lung compression
A

A

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23
Q

Small cell cancers

A

Out cell carcinoma

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24
Q

non-small cell cancers

A

large cell carcinoma, Squamous carcinoma, Adenocarcinoma

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25
Q

Your pt with a large pneumothorax has tachycardia and hypotension would could cause this

A

Decreased venous return to the heart

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26
Q

A patient is having a thoracentesis performed to drain 1500cc of fluid of the lung. during this procedure , which apply?
I. BP should be monitored
II. THe pt should be supine with the affected lung up
III. Pt should be sitting upright, leaning forward
IV. Needle is inserted between the 2-3 intercostal space
V. Needle is inserted between the 4-5 intercostal space

A

III, V , and I

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27
Q

ARDS undergo which of the following changes?
I. Atelectasis
II. Increased alveolar capillary membrane permeability
III. Interstitial and intraalveolar edema
IV. Hemorrhagic alveolar consolidation

A

all of the above

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28
Q

What is the possible lung finding under the fractured ribs of a flail chest

A

contusion

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29
Q

Treatment of 40% pneumothorax may include
I. ET intubation
II. Supp O2
III. Chest tube in pleural space
IV. Chest tube into the pericardial space

A

II, III

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30
Q

Cause of transudate pleural effusion includes

A

Congestive heart failure, Pulmonary embolism

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31
Q 
The etiology of ARDS may come from a multitude of causative factures including which of the following
A. Aspiration Pneumonia
B. THoracic surgery
C. SEpsis
D. Shock
A

All of the above

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32
Q

Check valve puncture wound. Inspiration in , expiration cant get out, what kind of pneumothorax

A

tension pneumothorax

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33
Q

An iatrogenic pneumothorax may be caused by

A

positive pressure vent, lung biopsy, thoracentesis

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34
Q

The anatomic alternation caused by a pleural effusion is

A

Separation of the visceral and parietal pleura

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35
Q

Repeat pneumothoraces, what should physician do

A

pleuodesis

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36
Q 
Which of the following is / are recommended ventilation strategies for most pts with ards
I. High Tidal Volumes
II. Low tidal volumes
III. High resp rates
IV. Low resp rates
V. High FiO2
VI. As low of FiO2 as permissible
VII. High PEEP
VIII. Low peep
A

II. Low tidal volumes
III. High resp rates
VI. As low of FiO2 as permissible
VII. High PEEP

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37
Q

Ground glass on CXR =

A

ARDS

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38
Q

An empyema is

A

an infection and inflammation in the pleural space

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39
Q

Your pt with a flail chest has paradoxical chest movement. what would be seen with this

A

during inspiration, the fractured ribs move inward

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40
Q

What is the usual cause to hypoxemia in a flail chest pt

A

Alveolar atlectasis

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41
Q

Remove air from pneumothorax by

A

-5cmH2O via water seal pneumovac
Number 28 to 36 fr chest tube
Insert the tube anteriorly between 2-3 intercostal spaces
pt in semi fowlers to fowlers positon

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42
Q

ARDS norm begins to develop after how long from the initial lung insult

A

24-48 hours

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43
Q

Mild to moderate kyphoiscoliosis will manifest itsef clinically as an

A

Restrictive pulmonary disorder

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44
Q

Transudative pleural effusion

A

Think and watery fluid, Few RBCs

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45
Q

In severe cases of flail chest, which interventions needed

A

Pain management
Mech ventilation
PEEP

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46
Q

The diagnostic criteria used for defining ARDS in a pt is

A

Berlin definition of ARDS

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47
Q

What accounts for more than 80% of all the bacteria pneumonias

A

Streptococcal pneumonia

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48
Q

What infects almost all children by age two

A

Resp Synctial Virus

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49
Q

In the midwestern part of the US what is the most common fungal infection of the lungs

A

histoplasmosis

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50
Q

What is almost always the cause of acute epiglottis

A

Haemophilus influenza type b

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51
Q

In the absense of a secondary bacterial infection, lung inflammation caused by the aspiration of gastric fluids usually becomes insignificant in approx how many days

A

3 days

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52
Q

During early stages of lung absess, the pathological process is the same as that of

A

pneumonia

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53
Q

The most effective med used to treat a TB infection

A

isoniazid

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54
Q

Fungal infections are usually spread by

A

inhaling fungal spres

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55
Q

For long term tx of TB what other drug should be incorporated with the use of Isoniazid

A

Rifampin

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56
Q

Most pulm emboli are from

A

blood emboli

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57
Q

In pulmonary edema, fluid first moves into the

A

Perivascular interstitial space, Peribronchial intersitial spaces

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58
Q

Emphysema is characterized by

A

destruction of the alveoli and terminal bronchioles

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59
Q

What part of the lungs most affected by fungal infection

A

Upper lobes

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60
Q

Blood test for diagnosing TB

A

QuantiFERON-TB Gold Test

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61
Q

Albumin may be given to a pulm edema pt to

A

increase the Oncotic pressure

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62
Q

Best diagnositc indicator of a pneumonia formation is

A

chest radiograph (CXR)

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63
Q

For bacterial pneumonia, the first line of defense is usually

A

antibiotic therapy

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64
Q

Best test to detect PE

A

Spiral CT scan

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65
Q

Promote bronchodilation in COPD pt, correct med

A

duoneb

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66
Q

Pneumonias pathologic effect is gen involving alteration in

A

the alvioli

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67
Q 
Which of the following is a thrombolytic agent
A. Heparin
B. Coumadin
C. Lasix
D.  Streptokinase
A

D

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68
Q

hallmark of bronchiectasis

A

large quantities of foul smelling sputum

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69
Q

Pink puffer

A

chronic bronchitis

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70
Q

Blastomycosis is frequently connected by exposures to

A

forest soil and or decaying wood

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71
Q

The death of lung tissue that may result from an obstruction of the pulmonary artery is called

A

pulmonary infarction

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72
Q

Pt with bacterial pneumonia. what kills the invading bacteria

A

Macrophages, Polymorphonuclear leukocytes

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73
Q

Most common fungal infection in US

A

Histoplasmosis

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74
Q

Biomarker that would indicate the presence of airway inflammation in a pt with asthma

A

FeNO concentration

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75
Q

Test to diagnose bronchiectasis

A

CT of the chest

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76
Q

Lab value with chronic COPD pt with chronic hypoxemia

A

Increase Hgb and HCT

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77
Q

Bacterial pneumonias, sputum is

A

purulent yellow/ green

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78
Q

Most pneumonias are caused by

A

gram negative bacteria

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79
Q

Treat fungal diseases

A

amphotericin B

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80
Q

Diagnostic test to confirm CF

A

sweat test

81
Q

About 80% of all pts with CF demonstrate a deficiency in which of the following

  1. Fat soluble vitamins
  2. Water soluble vitamins
  3. Protein
  4. Fat
  5. Carbohydrates
  6. Sodium
  7. Potassium
A

1,3,4, and 6

82
Q

An albuterol neb treatment is affective in pt with PE T/F

83
Q 
All of the following are causes of cardiogenic pulmonary edema except
A. Myocardial infarction
B. Mitral Valve Disease
C. Allergic reaction to drugs
D. Congenital heart defects
84
Q

Digital clubbing is a cardinal sign of

A

Chronic hypoxia

85
Q

best tx to reverse P.E. using resp therapy modality would be

A

CPAP with 100% O2

86
Q

The best resp therapy tx plan for suspected pulmonary emboli would be

A

SVN with albuterol, Non rebreather mask with 100% O2

87
Q

Lasix in P.E is an example of

A

preload reducer

88
Q

Treat pleural effusion related to their pneumonia with

A

thoracentesis

89
Q

Major pathologic or structural changes seen in the lungs with pulmonary edema include

A

Atelectasis, bronchospasm, high surface tension of alveolar fluids, alveolar flooding

90
Q

When a lung abscess is seen on a CXR, a distinguishing factor is

A

air fluid level in a cavity

91
Q

Lab test used to identify hyper coagulation and supports the diagnosis of pulmonary embolism

92
Q

3 diagnositc tests that should be immediately done on pt with TB

A

Mantoux test
QuantiFERON-TB gold test
Sputum Test-Fluorescent acid fast stain test

93
Q

3 main factors that contribute to airway obstruction in asthma

A

Inflammation, Mucus accumulation, Bronchospasm

94
Q

Hallmark of bronchiectasis

A

Large quantities of foul smelling sputum

95
Q

CF can be both restrictive and obstructive

96
Q

Common causes of acquired bronchiectasis

A

Pulmonary tuberculosis

97
Q

Found in the tracheobronchial tree secretions of pts with CF

A

Pseudomonas Aeruginosa

98
Q

Kartagners syndrom is typically associated with what disease process

A

Bronchiectasis

99
Q

if one carrier and one non carrier of CF produce children there is a

A

50% chance the child will be unaffected, and will be an unaffected carrier

100
Q

Congenital causes of bronchiectasis

101
Q

oral form of corticosteroid

A

Prednisone

102
Q

CF diet

A

Increase protein, increase fat, added sodium, Supplemental fat soluble vitamins

103
Q

Biomarkers indicating the presence of airway inflammation in a pt with asthma

A

FeNO concentration

104
Q

Common tool for home use to assess the severity of asthma is

A

peak flow meter

105
Q

Extrinsic asthma is caused by

A

a specific antigenic agent

106
Q

Bronchiectasis is commonly found in

A

Lobe or segment, in the lower lobes

107
Q

Type of test might be performed in PFT lab to help diagnosis exercise induced asthma

A

methacholine challenge

108
Q

3 forms of bronchiectasis. they are

A

Cylindrical, Varicose, and Cystic

109
Q

Second drug to add after maintenance therapy of persistent asthma doesnt work

110
Q

Kartageners syndrome include the following pathologic key notes

A

defective cilia lining of resp tract
bronchiectasis
dextrocardial (heart on right side)
Rhinosinusitis

111
Q

Bronchiectasis are the bronchi dilated and constricted in an irregular fashion

A

Fusiform, varicose

112
Q

cultured in sputum of pts with infected bronchiectasis

A

Streptococcus, Pseudomonas, Haemophillus

113
Q

Advanced stages of CF, the pt generally demonstrates which of the following

  1. Bronchial breath sounds
  2. Dull percussion notes
  3. Diminished breath sounds
  4. Hyper resonant percussion notes
114
Q

Asthma symptoms that occur daily along with frequent nocturnal symptoms with limitations in physical activity, and FEV1 or PEF of <60%

A

Severe persistent asthma

115
Q

Sweat glands of CF secrete up to (sodium and chloride)

A

4-5x the normal amount

116
Q

Associated with severe CF?

  1. Decrease Hgb
  2. Increased CVP
  3. Decreased BS
  4. Increased pulmonary vascular resistance
117
Q

Pursed lip breathing increase PEEP and reduce

A

Air trapping

118
Q

What makes asthma different from COPD

A

The asthma pt has norm lung function between episodes

119
Q

A pt with exercised induced asthma is started on med regimine. the physician orders albuterol MDI for breath through symptoms but asks YOU what maintenance drug he should use. You might suggest

A

Cromolyn sodium

120
Q

Mast cell degranulation will release which of the following chemical mediators

A

Histamine, Leukotrines

121
Q

During an asthma attack, the smooth muscle of the bronchi may hypertrophy as much as

A

3 times normal thickness

122
Q

Common cause of nocturnal asthma

A

gastric reflux

123
Q

Asthma pt gaining control of asthma. What step should they initiate therapy

124
Q

Increase and decrease in pulse pressure associated with respiraton

A

pulsus paradoxus

125
Q

Onset of intrinsic asthma occurs at which age

126
Q

an early asthmatic resposne followed by a late asthmatic response is called

A

biphasic response

127
Q

Asthma pt sputum

A

Kirschman spirals, Charcot-leyden crystals

128
Q

Extrensic asthma is a heredity trait? t/f

129
Q

simplest ways to control asthma and reduce meds

A

reduce the exposure to risk factors

130
Q

Kirschman spirals are casts of

A

terminal and smallest airways

131
Q

Severe asthma CXR

A

Increased AP diameter (barrel chest), Flattened diaphragm, translucent lung fields

132
Q

an accessory muscle used to assist EXPIRATORY during and asthma attack is sternocleidomastoids T/F

133
Q

Wait how long between albuterol tx

A

10-20 minutes

134
Q

peak flows in the yellow range, you would except to hear

A

expiratory wheezing

135
Q

The latent phase is associated with which phenotype of asthma

A

excercise induced

136
Q

In GBS which of the following pathologic changes develop in the peripheral nerves

A

Inflammation, demyelination, Edema

137
Q

The onset of the signs and symptoms of myasthenia gravis are

A

slow and insidious
sudden and rapid
intermittent
often elusive

138
Q

Associated with near drowning victims

A 
Consolidation,
Bronchospasm
Increased alveoalr-capilalry membrane thickness
atelectasis
Excessive bronchial secretions
139
Q

Associated with GBS

A

alveiolar consolidation
mucous accumulation
atelectasis
resp muscle fatigue/failure

140
Q

GBS common in

A

whites and 50 yrs older

141
Q

Myesthenia common in

A

peak onset in females 15-35 years of age
often provoked by emotional upset
associated with receptor binding antibodies

142
Q

associated with near drowning pts

A

Frothy, pink. white sputum
Crackles/rales
decreased pH
Decreased SaO2

143
Q

pts with thermal injury have an acute upper airway obstruction

144
Q

associated with myasthenia gravis

A

mucus accumulation
alveolar hypoinflation
atelectasis

145
Q

antibodies believed to block the nerve impulse transmission at the neuromuscular junction in myasthenia gravis

146
Q

healing time for a second degree burn is

147
Q

normal cardiac output of an adult at rest

148
Q

Which phenotype is associated with the highest serum concentrate of alpha 1 antitrypsin

A

MM phenotype

149
Q

Barrel chest is a common sign of

150
Q

Pts with severe chronic bronchitis commonly have cor pulmonale

A

Pitting edema, Right sided heart enlargment

151
Q

Which type of emphysema causes an abnormal weakening and enlargement of the resp bronchioles and alveoli in the proximal portion of the acinus

152
Q

Cyanosis is a common sign of

A

Chronic bronchitis

153
Q

chronic bronchitis

  1. Bronchial walls are narrowed because of vasoconstriction
  2. Bronchial glands are enlarged
  3. Number of goblet cells is increased
  4. The number of cilia lining the bronchi increases
A
  1. Bronchial glands are enlarged

3. Number of goblet cells is increased

154
Q

Peripheral edema is a common sign with
A. Emphysema
B. Chronic bronchitis

A

Chronic bronchitis

155
Q

Alpha1 antitrypsin deficiency

A

asthma like side effects with no history

156
Q

Auscultation of the lungs noting decreased breath sounds, decreased heart sounds, and prolonged expiration is common
A. Emphysema
B. Chronic bronchitis

157
Q

Speaking of which, a prolonged expiration and increased I:E ratio is due to

A

Severe air trapping

158
Q

To promote bronchodilation in COPD pts , what would be the correct med to use

159
Q

Patients with COPD have which of the following radiologic findings

A
  1. Translucent (dark)lungs
  2. Flattened diaphragms
  3. Increased AP diameter
  4. Right ventricular enlargement
160
Q

Polycythemia is a common sign in
A. Emphysema
B. Chronic bronchitis

A

Chronic bronchitis

161
Q

A pt with suspected COPD comes into the ER via an ambulance with an SpO2 of 97% on NRB mask. the pt is breathing 14bpm and is somnolent and difficult to arouse. What oxygen should be taken at this time

A

Decrease the O2 level to obtain an SpO2 between 88%-92%

162
Q

An increased residual volume due to air trapping usually leads to an increase in which capacity

A

Total lung capacity

163
Q

Congested lung fields on CXR is common with
A. Emphysema
B. Chronic bronchitis

A

B, Chronic bronchitis

164
Q

Chronic bronchitis is characterized as

A

productive cough for three months year for two years in a row

165
Q

In chronic bronchitis

  1. The bronchial walls are narrowed bc of bronchoconstriction
  2. The bronchial glands are enlarged
  3. number of goblet cells is increased
  4. number of cilia lining the tracheobronchial tree is decreased
A

All of the above

166
Q

The DLCO of pts with severe emphysema is

167
Q

The DLCO is often normal with pts with
A. Emphysema
B. Chronic bronchitis

A

Chronic bronchitis

168
Q

The reason the DLCO is normal in emphysema is

A

the loss of surface area from alveolar destruction

169
Q

What bacteria is commonly found in the tracheobronchial tree of pts with chronic bronchitis

A

Haemophilus influenzae,

Streptococcus pneumonia

170
Q

SaO2 90%, immediately think, PaO2

A

is about 60mmhg

171
Q

Lung parenchyma in the CXR of a pt with emphysema appears

A

Dark, more translucent

172
Q

When administering supplemental oxygen to a COPD pt, the goal should be to

A

achieve a SaO2 of between 88& to 92%

173
Q

A diagnostic test to eveluate a COPD pt exercise tolerance would be

A

6 min walk with oximetry

174
Q

Which of the following is associated with pleurtic chest pain

  1. lung cancer
  2. pneumonia
  3. myocardial ischemia
  4. tuberculosis
175
Q

abnormal breathing patterns is associated with diabetic acidosis

A

kussmals respiration

176
Q

An increased CVP reading is commonly seen in a pt who

  1. has a severe pneumothorax
  2. Is receiving high positive pressure ventilation
  3. Has Cor Pulmonale
  4. Is in left sided heart failure
177
Q

Pathologic condition increases vocal fremitus

A

Atelectasis, pneumonia

178
Q

Wheezing is

A

Produced by bronchospasm
A cardinal sign of bronchial asthma
Usually heard as high pitched sounds

179
Q

VO2 increases in response to what

A
  1. Exercise
  2. Hyperthermia
  3. Body size
180
Q

Arrhythmias is there no cardiac output or BP

A

Ventricular fibrillation

181
Q

Lung compliance decreases, what is seen

A

Vt usually decreases

RR usually increases

182
Q

A general statement about lung restrictive disease would be that the lung volumes are decreased and the flow rate are normal or proporionately normal T/F

183
Q

Restrictive lung volumes are associated with pathologic condition that alter the anatomic structures of the lung, distal to the terminal bronchioles T/F

184
Q

Dull or soft percussion note would likely be heard in what pathologic condition

A

Pneumothorax

Atelectasis

185
Q

Normal CVP pressure

A

0 to 4 mmHg

186
Q

During acute alveolar hyperventilation, what occurs

A

pH increases, PaCO2 decreases (everything could increase, but pH)

187
Q

VO2 decreases in response to what

A

Hypthermia, Peripheral shunting

188
Q

Metabolic alkalosis can develop from which of the following

  1. Hyperchoremia
  2. Hyperkalemia
  3. Hypocholoremia
  4. Hypokalemia
A

Hypocholoremia
and
Hypokalemia

189
Q

Obstructive lung volume findings are associated with pathologic conditions that alter the tracheobronchial tree T/F

190
Q

Cardiac output and BP begins to decline when the HR increases

A

150-175bpm

191
Q

Oxygenation ranges

A 
Hyper oxygenation: >100
Normal oxygenation: 80-100
Mild hypoxia: 60-80
Moderate hypoxia: 40-60
Severe hypoxia: <40
192
Q

The one single limiting factor of the pulmonary diffusion capacity of carbon monoxide (DLCO) is

A

alveolar capillary membrane

193
Q

Four factors used in predicting a pts normal lung volumes and flowrates

A

gender
height
weight
race

194
Q

CaO2

A

(Hgb x 1.34 x SaO2) + (PaO2 x 0.003)

195
Q

CvO2

A

(Hgb x 1.34 x SvO2) + (PvO2 x 0.003)

196
Q

Total oxygen delivery (DO2)

A

Cardiac output (Qt) x (CaO2 x 10)

197
Q

Arterial-Venous O2 content difference

A

CaO2- CvO2

198
Q

O2 consumption (VO2)

A

cardiac outputQt x [C(a-v)O2 x 10]

199
Q

O2 extraction ratio

A

CaO2-CvO2/ CaO2

Pathophysiology (9 decks)

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