Final Exam Flashcards by meagan robinson

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

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

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

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Diabetic Ketoacidosis ABG

Comp metabolic acidosis

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Cardiac/ resp arrest ABG

Combined acidosis with severe hypoxia

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

B. I, III, IV

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Asthma is a what disease

obstructive

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During an extrinsic induced asthma episode, sputum tends to be

thick, whitish, tenacious

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

peak flow meter

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Zone system based on peak flow measurements

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

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

C. Corticosteroids

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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

B. Capillary shunting

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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?

Flail chest segment

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

II and III only

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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

I, II, and IV

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

I and III only

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

Collapse, Consolidation, Filling with fluid

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Flail chest is defined as

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

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Posterior curvature of the spine best describes

kyphosis

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

Restrictive disorder

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

5-10 days

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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

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Small cell cancers

Out cell carcinoma

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non-small cell cancers

large cell carcinoma, Squamous carcinoma, Adenocarcinoma

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

Decreased venous return to the heart

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

III, V , and I

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

all of the above

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

contusion

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

II, III

Cause of transudate pleural effusion includes

Congestive heart failure, Pulmonary embolism

``` 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 ```

All of the above

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

tension pneumothorax

An iatrogenic pneumothorax may be caused by

positive pressure vent, lung biopsy, thoracentesis

The anatomic alternation caused by a pleural effusion is

Separation of the visceral and parietal pleura

Repeat pneumothoraces, what should physician do

pleuodesis

``` 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 ```

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

Ground glass on CXR =

ARDS

An empyema is

an infection and inflammation in the pleural space

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

during inspiration, the fractured ribs move inward

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

Alveolar atlectasis

Remove air from pneumothorax by

-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

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

24-48 hours

Mild to moderate kyphoiscoliosis will manifest itsef clinically as an

Restrictive pulmonary disorder

Transudative pleural effusion

Think and watery fluid, Few RBCs

In severe cases of flail chest, which interventions needed

Pain management Mech ventilation PEEP

The diagnostic criteria used for defining ARDS in a pt is

Berlin definition of ARDS

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

Streptococcal pneumonia

What infects almost all children by age two

Resp Synctial Virus

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

histoplasmosis

What is almost always the cause of acute epiglottis

Haemophilus influenza type b

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

3 days

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

pneumonia

The most effective med used to treat a TB infection

isoniazid

Fungal infections are usually spread by

inhaling fungal spres

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

Rifampin

Most pulm emboli are from

blood emboli

In pulmonary edema, fluid first moves into the

Perivascular interstitial space, Peribronchial intersitial spaces

Emphysema is characterized by

destruction of the alveoli and terminal bronchioles

What part of the lungs most affected by fungal infection

Upper lobes

Blood test for diagnosing TB

QuantiFERON-TB Gold Test

Albumin may be given to a pulm edema pt to

increase the Oncotic pressure

Best diagnositc indicator of a pneumonia formation is

chest radiograph (CXR)

For bacterial pneumonia, the first line of defense is usually

antibiotic therapy

Best test to detect PE

Spiral CT scan

Promote bronchodilation in COPD pt, correct med

duoneb

Pneumonias pathologic effect is gen involving alteration in

the alvioli

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

hallmark of bronchiectasis

large quantities of foul smelling sputum

Pink puffer

chronic bronchitis

Blastomycosis is frequently connected by exposures to

forest soil and or decaying wood

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

pulmonary infarction

Pt with bacterial pneumonia. what kills the invading bacteria

Macrophages, Polymorphonuclear leukocytes

Most common fungal infection in US

Histoplasmosis

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

FeNO concentration

Test to diagnose bronchiectasis

CT of the chest

Lab value with chronic COPD pt with chronic hypoxemia

Increase Hgb and HCT

Bacterial pneumonias, sputum is

purulent yellow/ green

Most pneumonias are caused by

gram negative bacteria

Treat fungal diseases

amphotericin B

Diagnostic test to confirm CF

sweat test

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

1,3,4, and 6

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

FALSE

``` 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 ```

Digital clubbing is a cardinal sign of

Chronic hypoxia

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

CPAP with 100% O2

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

SVN with albuterol, Non rebreather mask with 100% O2

Lasix in P.E is an example of

preload reducer

Treat pleural effusion related to their pneumonia with

thoracentesis

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

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

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

air fluid level in a cavity

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

D-Dimer

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

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

3 main factors that contribute to airway obstruction in asthma

Inflammation, Mucus accumulation, Bronchospasm

Hallmark of bronchiectasis

Large quantities of foul smelling sputum

CF can be both restrictive and obstructive

True

Common causes of acquired bronchiectasis

Pulmonary tuberculosis

Found in the tracheobronchial tree secretions of pts with CF

Pseudomonas Aeruginosa

Kartagners syndrom is typically associated with what disease process

Bronchiectasis

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

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

Congenital causes of bronchiectasis

oral form of corticosteroid

Prednisone

CF diet

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

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

FeNO concentration

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

peak flow meter

Extrinsic asthma is caused by

a specific antigenic agent

Bronchiectasis is commonly found in

Lobe or segment, in the lower lobes

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

methacholine challenge

3 forms of bronchiectasis. they are

Cylindrical, Varicose, and Cystic

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

LABA

Kartageners syndrome include the following pathologic key notes

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

Bronchiectasis are the bronchi dilated and constricted in an irregular fashion

Fusiform, varicose

cultured in sputum of pts with infected bronchiectasis

Streptococcus, Pseudomonas, Haemophillus

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

1 and 4

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

Severe persistent asthma

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

4-5x the normal amount

Associated with severe CF? 1. Decrease Hgb 2. Increased CVP 3. Decreased BS 4. Increased pulmonary vascular resistance

2, 3, 4

Pursed lip breathing increase PEEP and reduce

Air trapping

What makes asthma different from COPD

The asthma pt has norm lung function between episodes

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

Cromolyn sodium

Mast cell degranulation will release which of the following chemical mediators

Histamine, Leukotrines

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

3 times normal thickness

Common cause of nocturnal asthma

gastric reflux

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

step 2

Increase and decrease in pulse pressure associated with respiraton

pulsus paradoxus

Onset of intrinsic asthma occurs at which age

40yrs

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

biphasic response

Asthma pt sputum

Kirschman spirals, Charcot-leyden crystals

Extrensic asthma is a heredity trait? t/f

true

simplest ways to control asthma and reduce meds

reduce the exposure to risk factors

Kirschman spirals are casts of

terminal and smallest airways

Severe asthma CXR

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

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

False

Wait how long between albuterol tx

10-20 minutes

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

expiratory wheezing

The latent phase is associated with which phenotype of asthma

excercise induced

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

Inflammation, demyelination, Edema

The onset of the signs and symptoms of myasthenia gravis are

slow and insidious sudden and rapid intermittent often elusive

Associated with near drowning victims

``` Consolidation, Bronchospasm Increased alveoalr-capilalry membrane thickness atelectasis Excessive bronchial secretions ```

Associated with GBS

alveiolar consolidation mucous accumulation atelectasis resp muscle fatigue/failure

GBS common in

whites and 50 yrs older

Myesthenia common in

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

associated with near drowning pts

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

pts with thermal injury have an acute upper airway obstruction

20-30%

associated with myasthenia gravis

mucus accumulation alveolar hypoinflation atelectasis

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

IgG

healing time for a second degree burn is

7-21 days

normal cardiac output of an adult at rest

4-6lpm

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

MM phenotype

Barrel chest is a common sign of

Emphysema

Pts with severe chronic bronchitis commonly have cor pulmonale

Pitting edema, Right sided heart enlargment

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

Panlobar

Cyanosis is a common sign of

Chronic bronchitis

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

2. Bronchial glands are enlarged | 3. Number of goblet cells is increased

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

Chronic bronchitis

Alpha1 antitrypsin deficiency

asthma like side effects with no history

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

Emphysema

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

Severe air trapping

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

duoneb

Patients with COPD have which of the following radiologic findings

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

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

Chronic bronchitis

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

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

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

Total lung capacity

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

B, Chronic bronchitis

Chronic bronchitis is characterized as

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

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

All of the above

The DLCO of pts with severe emphysema is

decreased

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

Chronic bronchitis

The reason the DLCO is normal in emphysema is

the loss of surface area from alveolar destruction

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

Haemophilus influenzae, | Streptococcus pneumonia

SaO2 90%, immediately think, PaO2

is about 60mmhg

Lung parenchyma in the CXR of a pt with emphysema appears

Dark, more translucent

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

achieve a SaO2 of between 88& to 92%

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

6 min walk with oximetry

Which of the following is associated with pleurtic chest pain 1. lung cancer 2. pneumonia 3. myocardial ischemia 4. tuberculosis

1, 2, 4

abnormal breathing patterns is associated with diabetic acidosis

kussmals respiration

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

Pathologic condition increases vocal fremitus

Atelectasis, pneumonia

Wheezing is

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

VO2 increases in response to what

1. Exercise 2. Hyperthermia 3. Body size

Arrhythmias is there no cardiac output or BP

Ventricular fibrillation

Lung compliance decreases, what is seen

Vt usually decreases | RR usually increases

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

True

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

True

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

Pneumothorax | Atelectasis

Normal CVP pressure

0 to 4 mmHg

During acute alveolar hyperventilation, what occurs

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

VO2 decreases in response to what

Hypthermia, Peripheral shunting

Metabolic alkalosis can develop from which of the following 1. Hyperchoremia 2. Hyperkalemia 3. Hypocholoremia 4. Hypokalemia

Hypocholoremia and Hypokalemia

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

True

Cardiac output and BP begins to decline when the HR increases

150-175bpm

Oxygenation ranges

``` Hyper oxygenation: >100 Normal oxygenation: 80-100 Mild hypoxia: 60-80 Moderate hypoxia: 40-60 Severe hypoxia: <40 ```

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

alveolar capillary membrane

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

gender height weight race

CaO2

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

CvO2

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

Total oxygen delivery (DO2)

Cardiac output (Qt) x (CaO2 x 10)

Arterial-Venous O2 content difference

CaO2- CvO2

O2 consumption (VO2)

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

O2 extraction ratio

CaO2-CvO2/ CaO2