Health Asses 4: Restrictive Flashcards
Which of the following restrictive lung diseases is primarily associated with environmental occupational hazards?
A) Pleural effusion
B) Kyphoscoliosis
C) Interstitial Pulmonary Fibrosis (IPF)
D) Ankylosing Spondylitis
Correct Answer: C) Interstitial Pulmonary Fibrosis (IPF)
Rationale: Interstitial Pulmonary Fibrosis can be caused by occupational exposure to harmful substances such as asbestos, silica, or coal dust. This differentiates it from the other listed conditions, which are not typically associated with occupational exposures. For example, pleural effusion can be secondary to many causes, including infection, malignancy, or heart failure. Kyphoscoliosis and Ankylosing Spondylitis are skeletal disorders that do not have a direct occupational environmental link.
Which of the following drugs is least likely to be implicated in drug-induced interstitial lung disease?
A) Cyclophosphamide
B) Methotrexate
C) Acetaminophen
D) Bleomycin
Correct Answer: C) Acetaminophen
Rationale: The drugs listed in the slide that are known to cause drug-induced interstitial lung disease include Bleomycin, Methotrexate, and Cyclophosphamide. Acetaminophen is commonly used as an analgesic and antipyretic and is not typically associated with interstitial lung disease.
In the context of restrictive lung disease, severe abdominal distension can primarily affect lung function by:
A) Inducing pleural effusion
B) Impairing chest wall compliance
C) Causing occupational lung diseases
D) Increasing the risk of drug-induced lung patholog
Correct Answer: B) Impairing chest wall compliance
Rationale: Severe abdominal distension can lead to elevation of the diaphragm and limit the expansion of the lungs, thus impairing chest wall compliance. This can create a restrictive pattern in lung function testing. The other options, such as pleural effusion or occupational lung diseases, are causes of restrictive lung disease not directly related to abdominal distension.
A patient diagnosed with a restrictive lung disease due to neuromuscular disorder is most likely to have which underlying condition?
A) Occupational asthma
B) Collagen vascular disease
C) Myasthenia Gravis
D) Silicosis
Correct Answer: C) Myasthenia Gravis
“Chest Wall” category
Rationale: Myasthenia Gravis, a neuromuscular disease that can lead to muscle weakness, is listed on the slide under ‘Neuromuscular Disease (Myasthenia/Guillain Barre)’. This disorder can impair respiratory muscle function (CHEST WALL), leading to a restrictive pattern on pulmonary function testing. The other conditions listed do not have a primary neuromuscular component that leads to restrictive lung disease.
Which of the following is a cause of parenchymal restrictive lung disease that is classified as ‘collagenogenic’?
A) Rheumatoid arthritis
B) Ankylosing Spondylitis
C) Morbid obesity
D) Pneumothorax
Correct Answer: A) Rheumatoid arthritis
Rationale: Rheumatoid arthritis is a collagen vascular disease which can cause interstitial lung disease, thus falling into the ‘collagenogenic’ category of parenchymal lung diseases. Ankylosing Spondylitis affects the chest wall and Morbid obesity affects the chest wall compliance, while Pneumothorax is classified under pleural causes of restrictive lung disease.
What is the primary characteristic of extra-parenchymal restrictive lung diseases as compared to parenchymal restrictive lung diseases?
A) They are characterized by abnormalities in the lung parenchyma itself.
B) They result mainly from pleural diseases and chest wall deformities.
C) They are predominantly caused by occupational exposures.
D) They are usually associated with drug-induced lung pathology.
Correct Answer: B) They result mainly from pleural diseases and chest wall deformities.
Rationale: Extra-parenchymal restrictive lung diseases are caused by factors external to the lung parenchyma, such as diseases of the pleura (e.g., pleural effusion, pleural fibrosis) and chest wall deformities (e.g., kyphoscoliosis). In contrast, parenchymal restrictive lung diseases involve the lung tissue itself, including the alveoli, interstitium, blood vessels, and bronchi.
Among the pleural causes of restrictive lung disease listed, which is most likely to be caused by direct trauma?
A) Pleural thickening
B) Pneumothorax
C) Pleural tumours
D) Pleural effusion
Correct Answer: B) Pneumothorax
Rationale: A pneumothorax, which is the presence of air in the pleural space causing lung collapse, can occur due to direct trauma to the chest. Pleural thickening may result from chronic inflammatory conditions, pleural tumours from neoplastic processes, and pleural effusion can have various causes including trauma but is not specifically due to direct trauma.
Which condition is not typically associated with chest wall-related restrictive lung diseases?
A) Morbid obesity
B) Kyphoscoliosis
C) Pleural tumours
D) Trauma
Correct Answer: C) Pleural tumours
Rationale: Chest wall-related restrictive lung diseases are conditions that affect the ability of the chest wall to expand, such as morbid obesity, kyphoscoliosis, and trauma. Pleural tumours, however, are associated with the pleura, not the chest wall, and therefore would not be classified under chest wall-related restrictive lung diseases.
Ankylosing Spondylitis primarily affects the lung function by:
A) Inducing pleural effusion
B) Reducing chest wall elasticity
C) Causing granulomatous disease
D) Leading to interstitial lung pathology
Correct Answer: B) Reducing chest wall elasticity
Rationale: Ankylosing Spondylitis is a form of chronic inflammation of the spine and the sacroiliac joints, which can lead to reduced chest wall elasticity due to stiffening of the spine and rib joints. This condition can result in a restrictive lung disease by limiting the ability of the chest wall to expand during breathing. It does not directly cause granulomatous disease or interstitial lung pathology, and it is not associated with pleural effusion as a primary complication.
In the context of restrictive lung disease (RLD), what does the abbreviation ‘DLCO’ stand for, and what does it measure?
A) Diffusing Capacity of the Lungs for Carbon Monoxide; it measures the efficiency of gas exchange in the lung alveoli.
B) Diastolic Lung Compliance Output; it measures the compliance of the lung tissue during diastole.
C) Dynamic Lung Capacity Optimization; it measures the ability of the lungs to maximize capacity with exertion.
D) Delayed Lung Clearance Onset; it measures the rate at which lungs clear out pollutants.
Correct Answer: A) Diffusing Capacity of the Lungs for Carbon Monoxide; it measures the efficiency of gas exchange in the lung alveoli.
Rationale: The DLCO test assesses the diffusing capacity of the lungs for carbon monoxide and is an important measure in the evaluation of gas exchange in the pulmonary alveoli. In RLD, there is typically a reduction in DLCO due to decreased surface area for gas diffusion.
Which lung volume is characteristically most reduced in restrictive lung disease (RLD)?
A) Tidal Volume (TV)
B) Total Lung Capacity (TLC)
C) Residual Volume (RV)
D) Expiratory Reserve Volume (ERV)
Correct Answer: B) Total Lung Capacity (TLC)
Rationale: In restrictive lung diseases, all lung volumes are typically decreased. However, Total Lung Capacity (TLC) is the most indicative and characteristically reduced volume, as RLD affects the overall expansion and compliance of the lungs.
Which of the following is a likely consequence of the V/Q mismatch caused by restrictive lung diseases?
A) Increased risk of pulmonary embolism
B) Right-to-left cardiac shunt
C) Hypoxemia
D) Hypercarbia
Correct Answer: C) Hypoxemia
Rationale: V/Q mismatch refers to the imbalance between ventilation (air flow) and perfusion (blood flow) in the lungs. In restrictive lung diseases, due to reduced surface area for gas exchange. As lung elasticity worsens, pts become symptomatic d/t hypoxia, inability to clear secretions, and hypoventilation
The increased FEV1:FVC ratio seen in restrictive lung disease is due to:
A) A proportionally greater reduction in FEV1 compared to FVC.
B) A proportionally greater reduction in FVC compared to FEV1.
C) An increase in both FEV1 and FVC, with a greater increase in FEV1.
D) An increase in both FEV1 and FVC, with a greater increase in FVC.
Correct Answer: B) A proportionally greater reduction in FVC compared to FEV1.
Rationale: In restrictive lung disease, both FEV1 (Forced Expiratory Volume in 1 second) and FVC (Forced Vital Capacity) are reduced due to decreased lung compliance. However, FVC is often more affected than FEV1, leading to a normal or increased FEV1:FVC ratio, which is in contrast to obstructive lung diseases where this ratio is decreased.
A patient with restrictive lung disease is most likely to exhibit which of the following symptoms first?
A) Cyanosis
B) Wheezing
C) Dyspnea on exertion
D) Chronic productive cough
Correct Answer: C) Dyspnea on exertion
Rationale: As lung elasticity worsens in restrictive lung disease, the patient’s ability to increase lung volume during physical activity is limited, often leading to dyspnea on exertion as an early symptom. Wheezing is more characteristic of obstructive pulmonary diseases, and chronic productive cough is generally associated with chronic bronchitis. Cyanosis is a late finding, indicative of severe hypoxemia.
A patient with a Total Lung Capacity (TLC) of 60% of the predicted value is classified as having which severity of restrictive lung disease (RLD)?
A) Mild
B) Moderate
C) Severe
D) Very Severe
Correct Answer: B) Moderate
Rationale: Based on the classification provided, a TLC of 60% of the predicted value falls into the category of moderate restrictive lung disease, which is defined as a TLC between 50-65% of the predicted value.
A patient’s pulmonary function test reveals a Total Lung Capacity (TLC) of 70% of the predicted value. This indicates:
A) The patient does not have restrictive lung disease.
B) The patient has mild restrictive lung disease.
C) The patient has a normal lung function.
D) The patient’s condition is inconsistent with restrictive lung disease.
Correct Answer: B) The patient has mild restrictive lung disease.
Rationale: According to the slide, a TLC that ranges from 65-80% of the predicted value is indicative of mild restrictive lung disease. Therefore, a TLC of 70% would fall within this range.
Which condition listed under ‘Acute Intrinsic Restrictive Lung Disease’ is most closely associated with a rapid onset following direct lung injury?
A) Aspiration
B) Neurogenic problems
C) High altitude
D) Upper airway obstruction
Correct Answer: A) Aspiration
Rationale: Aspiration refers to the inhalation of foreign material into the lungs, which can lead to direct lung injury and acute pulmonary edema. It often presents with a rapid onset following the aspiration event. The other conditions listed, such as neurogenic problems or high altitude, may lead to acute lung issues but are not primarily due to direct lung injury.
‘Guillain-Barré syndrome’ is categorized under which of the following in the provided list?
A) Acute Intrinsic Restrictive Lung Disease
B) Chronic Intrinsic Restrictive Lung Disease
C) Disorders of the Chest Wall, Pleura, and Mediastinum
D) Other
Correct Answer: C) Disorders of the Chest Wall, Pleura, and Mediastinum
Rationale: Guillain-Barré syndrome is listed under the category of ‘Neuromuscular disorders’ which falls under the broader classification of ‘Disorders of the Chest Wall, Pleura, and Mediastinum.’ It is a disorder that affects the peripheral nerves and can impact the muscles of respiration, leading to restrictive lung disease.
Which of the following is not a chronic intrinsic cause of restrictive lung disease?
A) Sarcoidosis
B) Hypersensitivity pneumonitis
C) Pneumothorax
D) Eosinophilic granuloma
Correct Answer: C) Pneumothorax
Rationale: Pneumothorax, which is the presence of air in the pleural space, is classified under ‘Disorders of the Chest Wall, Pleura, and Mediastinum’ and not as a chronic intrinsic cause of restrictive lung disease. Sarcoidosis, hypersensitivity pneumonitis, and eosinophilic granuloma are all chronic intrinsic conditions that can lead to restrictive lung patterns.
Which condition among the following is typically not associated with ‘Chronic Intrinsic Restrictive Lung Disease’?
A) Alveolar proteinosis
B) Muscular dystrophies
C) Lymphangioleiomyomatosis
D) Drug-induced pulmonary fibrosis
Correct Answer: B) Muscular dystrophies
Rationale: Muscular dystrophies are listed under ‘Chest Wall’ because they are primarily neuromuscular disorders that can lead to restrictive lung disease due to weakened respiratory muscles, rather than being intrinsic to the lung parenchyma. Alveolar proteinosis, lymphangioleiomyomatosis, and drug-induced pulmonary fibrosis are all intrinsic to the lung tissue and cause chronic restrictive lung disease.
The presence of which of the following conditions would most likely suggest a diagnosis of acute rather than chronic restrictive lung disease?
A) Upper airway obstruction (negative pressure)
B) Drug-induced pulmonary fibrosis
C) Obesity
D) Sarcoidosis
Correct Answer: A) Upper airway obstruction (negative pressure)
Rationale: Upper airway obstruction due to negative pressure is an acute event that can lead to restrictive lung disease due to the inability to generate sufficient negative pressure to inflate the lungs properly. In contrast, drug-induced pulmonary fibrosis, obesity, and sarcoidosis are associated with chronic processes leading to restrictive lung disease.
Which imaging modality is traditionally used to identify the characteristic findings of pulmonary edema mentioned in the text?
A) Computerized Tomography (CT) scan
B) Magnetic Resonance Imaging (MRI)
C) Chest X-Ray (CXR)
D) Positron Emission Tomography (PET) scan
Correct Answer: C) Chest X-Ray (CXR)
Rationale: Pulmonary edema is traditionally identified by bilateral, symmetric perihilar opacities on a Chest X-Ray (CXR). The text specifically refers to CXR as the imaging modality used to recognize the appearance of pulmonary edema.
In the context of Acute Respiratory Distress Syndrome (ARDS), what pathological finding is commonly present?
A) Cardiogenic intravascular fluid retention
B) Unilateral pulmonary opacities
C) Diffuse alveolar damage
D) Isolated pleural effusion
Correct Answer: C) Diffuse alveolar damage
Rationale: Diffuse alveolar damage is a common finding in the lungs of patients with ARDS and is associated with increased-permeability pulmonary edema. This is a hallmark of ARDS and indicates severe injury to the alveolar-capillary barrier.
The pulmonary edema fluid characterized by increased capillary permeability is likely to contain:
A) A low concentration of protein and few secretory products
B) A normal concentration of protein typical of plasma
C) A high concentration of protein and secretory products
D) Only secretory products without protein
Correct Answer: C) A high concentration of protein and secretory products
Rationale: Pulmonary edema that is due to increased capillary permeability, such as in non-cardiogenic edema, is characterized by a high concentration of protein and secretory products. This distinguishes it from cardiogenic pulmonary edema, which typically has a lower protein concentration.
What pathophysiologic process in pulmonary edema leads to ‘capillary stress failure’?
A) Decreased surfactant production by alveolar cells
B) Collapse of the alveolar air spaces
C) Mechanical or ischemic disruption of the alveolar-capillary barrier
D) Excessive mucous secretion in the bronchial passages
Correct Answer: C) Mechanical or ischemic disruption of the alveolar-capillary barrier
Rationale: ‘Capillary stress failure’ refers to the disruption of the alveolar-capillary barrier due to mechanical or ischemic stress. This barrier is crucial for maintaining fluid homeostasis in the lungs. When it is compromised, “fluid leaks into the interstitial and alveolar spaces”, leading to pulmonary edema.
What clinical finding is strongly associated with pulmonary edema due to increased capillary pressure?
A) Bilateral wheezing on auscultation
B) A pleural rub heard during the respiratory cycle
C) Bilateral symmetric perihilar opacities on imaging
D) Unilateral absence of breath sounds
Correct Answer: C) Bilateral symmetric perihilar opacities on imaging
Rationale: Bilateral symmetric perihilar opacities on a chest X-ray are typical findings in pulmonary edema, especially when caused by increased capillary pressure. This radiographic appearance reflects the accumulation of fluid around the central areas of the lungs adjacent to the hilum.
The edema fluid in pulmonary edema due to ARDS typically differs from cardiogenic pulmonary edema in which way?
A) It has a higher concentration of red blood cells.
B) It has a lower concentration of white blood cells.
C) It has a higher concentration of protein and secretory products.
D) It is typically more serous and less viscous.
Correct Answer: C) It has a higher concentration of protein and secretory products.
Rationale: Pulmonary edema fluid due to ARDS, a type of non-cardiogenic pulmonary edema, is characterized by increased capillary permeability, which leads to a high concentration of protein and secretory products in the edema fluid. This is a distinguishing feature from cardiogenic pulmonary edema, which generally has a lower protein content in the fluid.
How has bedside lung ultrasound altered the approach to diagnosing pulmonary edema?
A) It has replaced the need for chest X-ray imaging entirely.
B) It offers a rapid, non-invasive means to support the diagnosis at the patient’s bedside.
C) It has limited applicability due to the need for high technical expertise.
D) It is only used when traditional imaging methods are inconclusive.
Correct Answer: B) It offers a rapid, non-invasive means to support the diagnosis at the patient’s bedside.
Rationale: Bedside lung ultrasound has emerged as a valuable tool in the diagnosis of pulmonary edema, providing a rapid, non-invasive means to detect fluid accumulation in the lungs at the patient’s bedside. While it has not replaced traditional imaging methods like CXR or CT scans, it serves as a complementary tool, especially when immediate information is required.
In cardiogenic pulmonary edema, activation of which system contributes to the clinical symptoms?
A) Parasympathetic nervous system
B) Sympathetic nervous system
C) Renin-angiotensin-aldosterone system
D) Peripheral nervous system
Correct Answer: B) Sympathetic nervous system
Rationale: Cardiogenic pulmonary edema is characterized by symptoms such as marked dyspnea, tachypnea, and elevated cardiac pressures. These symptoms are exacerbated by the activation of the Sympathetic Nervous System (SNS), which is more pronounced in cardiogenic compared to non-cardiogenic pulmonary edema.
Cardiogenic pulmonary edema should be suspected in a patient with decreased cardiac function and which of the following conditions?
A) Chronic hypertension
B) Acute aortic regurgitation
C) Chronic obstructive pulmonary disease
D) Pulmonary embolism
Correct Answer: B) Acute aortic regurgitation
Rationale: The risk of cardiogenic pulmonary edema is increased with conditions that acutely increase preload, such as acute aortic regurgitation and acute mitral valve regurgitation. These conditions can lead to sudden volume overload in the left ventricle, contributing to the development of pulmonary edema.
What condition primarily increases afterload, leading to a higher risk of cardiogenic pulmonary edema?
A) Mitral valve prolapse
B) Atrial septal defect
C) Left ventricular outflow tract (LVOT) obstruction
D) Tricuspid regurgitation
Correct Answer: C) Left ventricular outflow tract (LVOT) obstruction
Rationale: Conditions that increase afterload, such as Left Ventricular Outflow Tract (LVOT) obstruction, mitral stenosis, and renovascular hypertension, can lead to an increased risk of cardiogenic pulmonary edema. LVOT obstruction increases the resistance against which the heart must pump, leading to elevated cardiac pressures and contributing to pulmonary edema.
When evaluating a patient for possible cardiogenic pulmonary edema, which diagnostic finding would corroborate decreased cardiac function as a potential cause?
A) Elevated peak expiratory flow rate
B) Diminished ejection fraction on echocardiography
C) Increased forced vital capacity on spirometry
D) Broadened QRS complex on electrocardiogram
Correct Answer: B) Diminished ejection fraction on echocardiography
Rationale: A decreased ejection fraction observed on echocardiography indicates diminished systolic cardiac function, which can be a contributing factor to cardiogenic pulmonary edema. Echocardiography is a key diagnostic tool for assessing cardiac function, including both systolic and diastolic function. Reduced ejection fraction specifically points to decreased systolic performance, which is when the heart has difficulty effectively pumping blood out into the systemic circulation, potentially leading to pulmonary congestion and edema.
Which of the following is NOT a consistent clinical presentation of the initial sx of cardiogenic pulmonary edema due to compensatory mechanisms?
A) Hypotension
B) Tachypnea
C) Elevated cardiac pressures
D) Marked dyspnea
Correct Answer: A) Hypotension
Rationale: In cardiogenic pulmonary edema, blood pressure may be maintained at normal or even elevated levels initially due to compensatory mechanisms, such as activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system, despite decreased cardiac function. Over time, if the heart failure progresses and these mechanisms are overwhelmed, blood pressure may then fall. Therefore, the presence of normal or elevated blood pressure does not rule out cardiogenic pulmonary edema, particularly in the early compensatory stage of heart failure. Tachypnea, elevated cardiac pressures, and marked dyspnea are more consistent features of cardiogenic pulmonary edema.
What is the primary mechanism by which negative pressure pulmonary edema (NPPE) develops after acute upper airway obstruction is relieved?
A) Increased capillary hydrostatic pressure due to positive pressure ventilation
B) Increased left ventricular preload and afterload due to intense inspiratory efforts against an obstruction
C) Decreased pulmonary interstitial hydrostatic pressure due to systemic vasodilation
D) Decreased venous return due to high intrathoracic pressures
Correct Answer: B) Increased left ventricular preload and afterload due to intense inspiratory efforts against an obstruction
Rationale: Negative pressure pulmonary edema develops when there is a sudden relief from an upper airway obstruction. The vigorous inspiratory efforts against the obstruction lead to a decrease in intrapleural pressure which in turn increases the venous return to the heart (preload) and increases the left ventricular afterload. The negative intrathoracic pressure generated also increases the transmural pressure gradient across the pulmonary capillary bed, promoting the transudation of fluid into the alveolar and interstitial spaces.
Which of the following conditions is least likely to be a cause of negative pressure pulmonary edema (NPPE)?
A) Obstructive Sleep Apnea (OSA)
B) Bronchial asthma
C) Laryngospasm
D) Epiglottitis
Correct Answer: B) Bronchial asthma
Rationale: NPPE is specifically associated with the relief of an acute upper airway obstruction, which includes conditions like laryngospasm, epiglottitis, and obstructive sleep apnea (OSA), where the obstruction is at the level of the upper airway. Bronchial asthma is a lower airway disorder characterized by bronchoconstriction, inflammation, and increased mucus production, and is not a common cause of NPPE.
In negative pressure pulmonary edema, the intense activation of which body system contributes to the pathophysiology?
A) Gastrointestinal system due to reflux and aspiration
B) Sympathetic nervous system due to stress response
C) Urinary system due to alterations in renal perfusion
D) Endocrine system due to hormonal dysregulation
Correct Answer: B) Sympathetic nervous system due to stress response
Rationale: NPPE is characterized by intense sympathetic nervous system (SNS) activation as a result of the stress response to acute airway obstruction and negative intrathoracic pressures. This leads to hypertension (HTN) and central displacement of blood volume, which are contributory factors in the development of pulmonary edema.
What time frame is commonly observed for the onset of pulmonary edema following the relief of an obstruction in NPPE?
A) Within a few seconds to minutes
B) A few minutes to 2-3 hours
C) 12-24 hours after the obstruction is relieved
D) Several days post-obstruction relief
Correct Answer: B) A few minutes to 2-3 hours
Rationale: The onset of NPPE can vary, but typically it ranges from a few minutes to 2-3 hours after the relief of the upper airway obstruction. It is an acute event that follows the pathophysiological sequence of relief from the obstruction, increased venous return, increased left ventricular afterload, and finally the transudation of fluid into the lungs.
What role does the decrease in intrapleural pressure play in the pathophysiology of negative pressure pulmonary edema?
A) It leads to a reduction in the alveolar surface area for gas exchange.
B) It increases the interstitial hydrostatic pressure, preventing fluid extravasation.
C) It causes a decrease in venous return, reducing cardiac output.
D) It results in increased venous return and left ventricular afterload, contributing to pulmonary edema.
Correct Answer: D) It results in increased venous return and left ventricular afterload, contributing to pulmonary edema.
Rationale: In the setting of negative pressure pulmonary edema, a significant decrease in intrapleural pressure, particularly due to forceful inspiratory efforts against an obstructed airway, enhances venous return to the right side of the heart. This increased preload, along with the negative pressure exerted on the lung vasculature, leads to an increased left ventricular afterload. The augmented afterload, coupled with the stress response-induced hypertension, intensifies the pressure in the left side of the heart. These hemodynamic changes, together with the negative pressure’s effect on the pulmonary capillaries, facilitate the translocation of fluid from the capillaries into the interstitial and alveolar spaces, resulting in pulmonary edema.
For the treatment of Negative Pressure Pulmonary Edema (NPPE), what is the mainstay of therapy?
A) Administration of corticosteroids
B) Providing supplemental oxygen and ensuring airway patency
C) Immediate intubation and prolonged mechanical ventilation
D) Diuretics and fluid restriction
Correct Answer: B) Providing supplemental oxygen and ensuring airway patency
Rationale: The mainstay of treatment for NPPE involves providing supplemental oxygen to address hypoxemia and ensuring that the airway is patent to facilitate adequate ventilation. NPPE is usually self-limited, and these supportive measures are typically sufficient while the edema resolves spontaneously.
How long does it typically take for radiographic evidence of NPPE to resolve after treatment initiation?
A) Within 1-2 hours
B) Within 12-24 hours
C) 3-5 days post-treatment
D) Up to a week or more
Correct Answer: B) Within 12-24 hours
Rationale: The radiographic evidence of NPPE generally resolves relatively quickly, usually within 12-24 hours after the episode. This resolution coincides with the self-limiting nature of the condition and the effectiveness of supportive care including oxygen therapy and ensuring a patent airway.
Mechanical ventilation is employed in the treatment of NPPE under what circumstances?
A) As a preventive measure in all cases of NPPE
B) Routinely, immediately upon diagnosis
C) When supplemental oxygen and a patent airway do not suffice
D) Only after radiographic evidence fails to resolve in 24 hours
Correct Answer: C) When supplemental oxygen and a patent airway do not suffice
Rationale: Mechanical ventilation may be required in the treatment of NPPE if the initial management with supplemental oxygen and maintaining a patent airway is not effective in relieving hypoxemia and respiratory distress. It is not used preventively in all cases nor routinely upon diagnosis but is reserved for cases where conservative measures are inadequate.
What is the primary mechanism by which neurogenic pulmonary edema develops following an acute CNS injury?
A) Altered pulmonary capillary permeability secondary to infection
B) Generalized vasoconstriction and blood volume shift into the pulmonary circulation due to sympathetic nervous system discharge
C) Primary failure of the left side of the heart leading to back-pressure
D) Chronic elevation of pulmonary venous pressure due to renal artery stenosis
Correct Answer: B) Generalized vasoconstriction and blood volume shift into the pulmonary circulation due to sympathetic nervous system discharge
Rationale: Neurogenic pulmonary edema is caused by a massive sympathetic discharge following an acute CNS injury. This outpouring of sympathetic impulses leads to generalized vasoconstriction and a consequent shift of blood volume into the pulmonary circulation, increasing pulmonary capillary pressure, and promoting the translocation of fluid into the pulmonary interstitium and alveoli.
In what timeframe does neurogenic pulmonary edema typically manifest after a central nervous system (CNS) injury?
A) 1-2 weeks following the injury
B) 24-48 hours after the injury
C) Minutes to hours after the injury
D) Immediately at the moment of injury
Correct Answer: C) Minutes to hours after the injury
Rationale: Neurogenic pulmonary edema can develop rapidly, often within minutes to hours after an acute CNS injury. It may present during the perioperative period, which is a critical time when the patient is under close observation, and any acute changes in respiratory function can be readily noted and addressed.
Beyond fluid translocation, what other direct consequence can result from the pathophysiological changes of neurogenic pulmonary edema?
A) Decrease in pulmonary compliance due to fibrotic changes
B) Injury to pulmonary blood vessels due to pulmonary hypertension and hypervolemia
C) Obstruction of the upper airways due to laryngeal edema
D) Increased risk of pneumonia due to aspiration
Correct Answer: B) Injury to pulmonary blood vessels due to pulmonary hypertension and hypervolemia
Rationale: The increased pulmonary capillary pressure and blood volume within the pulmonary circulation, secondary to intense sympathetic nervous system activation in neurogenic pulmonary edema, can lead to pulmonary hypertension and hypervolemia. These changes increase the stress on pulmonary blood vessels, which can result in injury to the vessel walls.
What is a key risk factor for the development of re-expansion pulmonary edema (REPE)?
A) A gradual, controlled expansion of a collapsed lung
B) Presence of less than 1 liter of air or fluid in the pleural space
C) Duration of lung collapse less than 24 hours
D) Rapid re-expansion of a collapsed lung
Correct Answer: D) Rapid re-expansion of a collapsed lung
Rationale: One of the key risk factors for REPE is the rapid re-expansion of a collapsed lung. This can cause a sudden shift in pressures within the thoracic cavity and lead to the development of pulmonary edema. A more controlled re-expansion is less likely to cause REPE.
What does the presence of a high protein content in pulmonary edema fluid indicate about the pathophysiology of REPE?
A) Decreased lymphatic drainage from the lung parenchyma
B) Increased capillary hydrostatic pressure
C) Enhanced capillary membrane permeability
D) Reduction in plasma oncotic pressure
Correct Answer: C) Enhanced capillary membrane permeability
Rationale: The high protein content in the edema fluid of REPE suggests that the underlying mechanism involves enhanced permeability of the pulmonary capillary membrane, allowing proteins to pass from the capillaries into the alveolar space.
Regarding the supportive care treatment for REPE, which of the following interventions is typically included?
A) Aggressive diuretic therapy
B) Supplemental oxygen and careful fluid management
C) Immediate surgical intervention
D) Systemic administration of vasodilators
Correct Answer: B) Supplemental oxygen and careful fluid management
Rationale: Supportive care for REPE typically includes supplemental oxygen to maintain adequate oxygenation and careful fluid management to prevent further exacerbation of pulmonary edema. It aims to support the patient’s respiratory function while the condition resolves spontaneously.
Which factor increases the risk of REPE after a pneumothorax or pleural effusion is resolved?
A) Smaller volume of air or fluid in the pleural space
B) Shorter duration of lung collapse
C) Slower rate of lung re-expansion
D) Larger volume of air or fluid in the pleural space
Correct Answer: D) Larger volume of air or fluid in the pleural space
Rationale: A larger volume of air or liquid in the pleural space (>1 liter) increases the risk of developing REPE when the lung is re-expanded. The pleural space’s capacity to accommodate large volumes can lead to significant changes in intrapleural pressure during re-expansion.
The duration of lung collapse considered to increase the risk for REPE is:
A) Less than 12 hours
B) More than 24 hours
C) Between 12 and 24 hours
D) Any duration of lung collapse
Correct Answer: B) More than 24 hours
Rationale: The risk of REPE is increased if the lung has been collapsed for an extended period, particularly more than 24 hours. Longer durations of collapse can lead to alterations in lung and pleural space physiology that contribute to the risk of edema upon re-expansion.
What is indicated by the high protein concentration in pulmonary edema fluid caused by drug use?
A) Cardiogenic etiology of the pulmonary edema
B) Increased capillary permeability contributing to the edema
C) Renal origin of the pulmonary edema
D) Low oncotic pressure in the pulmonary circulation
Correct Answer: B) Increased capillary permeability contributing to the edema
Rationale: A high protein concentration in pulmonary edema fluid is indicative of increased capillary permeability, also known as non-cardiogenic or high-permeability pulmonary edema. This type of edema is characteristic of drug-induced pulmonary edema rather than cardiogenic causes, which usually result in a transudative edema with lower protein content.
Cocaine-induced pulmonary edema is associated with what additional cardiovascular effect?
A) Bradycardia
B) Pulmonary vasodilation
C) Pulmonary vasoconstriction and myocardial ischemia
D) Reduction of systemic vascular resistance
Correct Answer: C) Pulmonary vasoconstriction and myocardial ischemia
Rationale: Cocaine can induce pulmonary edema through its effects on the cardiovascular system, which include causing pulmonary vasoconstriction and the potential to induce acute myocardial ischemia. These effects contribute to the development of pulmonary edema.
Why is naloxone not effective in reversing opioid-induced pulmonary edema?
A) It only reverses the sedative effects of opioids, not the respiratory or cardiovascular effects.
B) It increases pulmonary vascular permeability.
C) It cannot cross the blood-brain barrier.
D) Opioid-induced pulmonary edema is not mediated by opioid receptors.
Correct Answer: D) Opioid-induced pulmonary edema is not mediated by opioid receptors.
Rationale: Naloxone is an opioid antagonist that reverses the central nervous system effects of opioids, including respiratory depression. However, opioid-induced pulmonary edema is a non-receptor-mediated effect. Therefore, naloxone does not reverse the pulmonary complications associated with opioid overdose.
What is a likely treatment approach for a patient with drug-induced pulmonary edema who is experiencing respiratory distress?
A) Oral corticosteroids
B) Intubation and mechanical ventilation
C) High-dose beta-blockers
D) Immediate dialysis
Correct Answer: B) Intubation and mechanical ventilation
Rationale: Supportive care, including intubation and mechanical ventilation, may be necessary for the treatment of drug-induced pulmonary edema, especially if the patient is in respiratory distress. This helps maintain adequate oxygenation and ventilation while the effects of the drug subside and the edema resolves.
Diffuse alveolar hemorrhage (DAH) should be considered when a patient with pulmonary edema does not respond to which type of treatment?
A) Diuretics
B) Antibiotics
C) Antivirals
D) Antifungals
Correct Answer: A) Diuretics
Rationale: If a patient’s pulmonary edema is refractory to diuretic treatment, it suggests that the edema may not be of cardiogenic origin. Diffuse alveolar hemorrhage (DAH) is a condition that presents with similar symptoms to pulmonary edema but involves bleeding into the alveoli. It is not typically responsive to diuretics, as the issue is related to bleeding rather than fluid overload.
High-Altitude Pulmonary Edema (HAPE) is most likely to occur at what minimum altitude?
A) 1500m
B) 2500m
C) 3500m
D) 4500m
Correct Answer: B) 2500m
Rationale: HAPE can occur at altitudes typically ranging from 2500 to 5000 meters above sea level. The risk increases with the rate of ascent to high altitude and with higher altitudes.
The pathophysiology of HAPE involves which primary mechanism?
A) Allergic reactions to decreased atmospheric pressure
B) Hypoxic pulmonary vasoconstriction leading to increased pulmonary vascular pressure
C) Bacterial infection secondary to immune system suppression at high altitude
D) Overhydration due to excessive fluid intake at high altitudes
Correct Answer: B) Hypoxic pulmonary vasoconstriction leading to increased pulmonary vascular pressure
Rationale: The primary mechanism thought to cause HAPE is hypoxic pulmonary vasoconstriction in response to the lower oxygen levels at high altitudes. This hypoxia-induced response increases pulmonary vascular pressure and can lead to a high-permeability type of pulmonary edema.
What is the typical time frame for the onset of HAPE after reaching a high altitude?
A) Within the first 6-12 hours
B) 12-24 hours
C) 24-48 hours
D) 48-72 hours
Correct Answer: D) 48-72 hours
Rationale: HAPE usually develops gradually and typically manifests within 48-72 hours after arrival at a high altitude.
Which treatment is indicated for immediate management of HAPE?
A) Supplemental oxygen and rapid ascent to a higher altitude for acclimatization
B) Diuretics and maintenance at the current altitude
C) Supplemental oxygen and rapid descent to a lower altitude
D) Antibiotic therapy and continuation of physical exertion
Correct Answer: C) Supplemental oxygen and rapid descent to a lower altitude
Rationale: Immediate treatment for HAPE includes administration of supplemental oxygen and a rapid descent to a lower altitude, which are critical for reducing hypoxia and pulmonary arterial pressure, thereby alleviating symptoms.
What adjunct therapy may improve oxygenation in a patient with HAPE?
A) Beta-2 agonists
B) Inhalation of nitric oxide
C) Oral corticosteroids
D) Antihistamines
Correct Answer: B) Inhalation of nitric oxide
Rationale: Inhalation of nitric oxide is a treatment option that may improve oxygenation in HAPE by causing vasodilation in the pulmonary vasculature, thus reducing pulmonary hypertension and aiding in the relief of edema
In patients with pulmonary edema, elective surgery should be approached with which of the following considerations?
A) Proceeding as planned to avoid delay
B) Postponement until cardiorespiratory function is optimized
C) Immediate surgery to resolve the pulmonary edema
D) Surgery without any special preparations
Correct Answer: B) Postponement until cardiorespiratory function is optimized
Rationale: Elective surgery should be delayed in patients with pulmonary edema, and efforts should be made to optimize cardiorespiratory function before proceeding with surgery. This helps to minimize perioperative risks and complications related to the edema.
What ventilatory strategy is indicated for patients with pulmonary edema under anesthesia?
A) High tidal volume (TV) ventilation to ensure adequate oxygenation
B) Low tidal volume (TV) ventilation and a respiratory rate (RR) of 14-18 breaths per minute
C) High-frequency ventilation to maximize oxygen delivery
D) Low respiratory rate (RR) to minimize oxygen consumption
Correct Answer: B) Low tidal volume (TV) ventilation and a respiratory rate (RR) of 14-18 breaths per minute
Rationale: Current evidence supports the benefit of ventilation using low tidal volume and a respiratory rate of 14-18 while keeping end-inspiratory plateau pressures below 30 cm H2O. This approach can help to prevent additional lung injury caused by mechanical ventilation, such as ventilator-induced lung injury (VILI).
Which monitoring is particularly useful in the assessment and treatment of pulmonary edema in the perioperative setting?
A) Neurological monitoring with EEG
B) Hemodynamic monitoring
C) Continuous temperature monitoring
D) Intraoperative glucose monitoring
Correct Answer: B) Hemodynamic monitoring
Rationale: Hemodynamic monitoring is particularly useful in the assessment and treatment of pulmonary edema, as it helps in understanding the fluid status and cardiac function of the patient, thereby guiding appropriate fluid management and cardiovascular support.
What does the recommendation to carefully titrate PEEP with an inspiratory pause aim to achieve in patients with pulmonary edema?
A) Reduce the respiratory rate to avoid hyperventilation
B) Optimize lung compliance and oxygenation
C) Increase cardiac preload and improve cardiac output
D) Minimize the risk of nosocomial infections
Correct Answer: B) Optimize lung compliance and oxygenation
Rationale: The careful titration of positive end-expiratory pressure (PEEP) along with an inspiratory pause is recommended to optimize lung compliance, which can be reduced in pulmonary edema. This helps to enhance oxygenation while minimizing potential ventilator-induced lung injury.
In the context of extubation criteria, why should tachypnea not be the sole determinant in patients with restrictive lung disease (RLD)?
A) Patients with RLD can have rapid, shallow breathing as a baseline.
B) Tachypnea indicates improved lung function and readiness for extubation.
C) Tachypnea is a normal response to anesthesia and surgery.
D) Tachypnea is unrelated to lung diseases and is purely a cardiac symptom.
Correct Answer: A) Patients with RLD can have rapid, shallow breathing as a baseline.
Rationale: Patients with restrictive lung disease often present with rapid, shallow breathing as a baseline respiratory pattern due to their decreased lung compliance. Therefore, tachypnea should not be used as the sole criterion for delaying extubation if gas exchange and other assessments are satisfactory.
Which patients are particularly at risk for developing chemical pneumonitis?
A) Patients with heightened airway reflexes
B) Patients with decreased airway reflexes
C) Patients with a history of chronic obstructive pulmonary disease
D) Patients with pre-existing pulmonary hypertension
Correct Answer: B) Patients with decreased airway reflexes
Rationale: Patients with decreased airway reflexes are at an increased risk for aspiration, which can lead to chemical pneumonitis. These reflexes are critical for protecting the airway during swallowing and other times when foreign material could enter the respiratory tract.
What is the purpose of elevating the head of the bed (HOB) during intubation and extubation?
A) To improve venous return and cardiac output
B) To decrease the risk of ventilator-associated pneumonia
C) To reduce the risk of aspiration
D) To enhance patient comfort and reduce anxiety
Correct Answer: C) To reduce the risk of aspiration
Rationale: Elevating the head of the bed (HOB) during intubation and extubation is a maneuver to decrease the risk of aspiration. By using gravity, this position helps prevent gastric contents from entering the respiratory tract if regurgitation occurs.
Which of the following is a common presenting symptom of chemical pneumonitis?
A) Gradual onset of wheezing
B) Abrupt onset of dyspnea, tachycardia, and desaturation
C) Slowly progressive cough with sputum production
D) Chronic shortness of breath with exertion
Correct Answer: B) Abrupt onset of dyspnea, tachycardia, and desaturation
Rationale: Chemical pneumonitis usually presents with an abrupt onset of symptoms such as dyspnea, tachycardia, and desaturation due to the acute inflammatory response in the lungs after aspiration of gastric contents.
If a chest x-ray (CXR) is taken immediately after a suspected aspiration event, what is the likely finding?
A) Clear evidence of aspiration pneumonitis
B) No evidence of aspiration pneumonitis
C) Widespread alveolar infiltrates
D) Opacities in the superior segment of the RLL
Correct Answer: B) No evidence of aspiration pneumonitis
Rationale: A chest x-ray may not show evidence of aspiration pneumonitis for 6-12 hours following the aspiration event. The radiographic changes take time to develop as the inflammatory response evolves in the lung parenchyma.
In a patient who has aspirated in the supine position, where is the radiographic evidence of aspiration most likely to be found?
A) The basal segments of the lower lobes
B) The apical segments of the upper lobes
C) The superior segment of the right lower lobe (RLL)
D) The middle lobe and lingula
Correct Answer: C) The superior segment of the right lower lobe (RLL)
Rationale: If a patient aspirates in the supine position, the aspirated material is most likely to be found in the superior segment of the right lower lobe due to the anatomical orientation of the bronchial tree and the effect of gravity on the aspirated contents.
In the event of an aspiration, what is the first step in patient management?
A) Administer a broad-spectrum antibiotic immediately.
B) Suction the oropharynx and turn the patient to the side.
C) Start positive pressure ventilation to clear the aspirate.
D) Perform a bronchoscopy to assess the extent of aspiration.
Correct Answer: B) Suction the oropharynx and turn the patient to the side.
Rationale: If aspiration is noted, immediate suctioning of the oropharynx and turning the patient to the side are important to prevent further aspiration and to clear the already aspirated material from the oropharynx.
What is the role of the Trendelenburg (T-burg) position in managing aspiration?
A) It can stop the reflux of gastric contents.
B) It can facilitate the return of aspirated contents back to the stomach.
C) It prevents aspiration once gastric contents are in the pharynx.
D) It is used to induce vomiting and clear the airway.
Correct Answer: C) It prevents aspiration once gastric contents are in the pharynx.
Rationale: The Trendelenburg position will not stop an active reflux, but if gastric contents have refluxed into the pharynx, it can prevent further aspiration by using gravity to keep the contents from moving into the lower respiratory tract.
Why might gastric fluid pH measurement be useful in chemical pneumonitis?
A) It determines the viscosity of the aspirated fluid.
B) It helps in choosing the appropriate antibiotic.
C) It reflects the pH of the aspirated fluid and its potential for causing lung injury.
D) It indicates the presence of blood in the aspirated material.
Correct Answer: C) It reflects the pH of the aspirated fluid and its potential for causing lung injury.
Rationale: Measurement of gastric fluid pH is useful in chemical pneumonitis because the acidity of the aspirated fluid can cause lung injury. A lower pH is associated with a higher risk of chemical injury to the lungs.
Why is lavage typically not useful in the treatment of aspiration pneumonitis?
A) The aspirated material is too viscous to be removed by lavage.
B) Aspirated gastric fluid is rapidly redistributed in the lungs, making it difficult to remove.
C) Lavage can exacerbate the chemical injury to the lung.
D) Lavage increases the risk of spreading infection.
Correct Answer: B) Aspirated gastric fluid is rapidly redistributed in the lungs, making it difficult to remove.
Rationale: Once gastric fluid is aspirated, it quickly spreads to peripheral lung regions, making it difficult to remove by lavage. Additionally, lavage may not be effective in removing the fluid and could potentially exacerbate the situation by spreading it further or causing additional trauma.
When might antibiotics be considered in the management of aspiration pneumonitis?
A) As an immediate preventive measure following aspiration
B) If the patient remains symptomatic after 48 hours and has positive culture results
C) If gastric fluid pH is very low
D) They are always indicated regardless of symptoms and culture results
Correct Answer: B) If the patient remains symptomatic after 48 hours and has positive culture results
Rationale: Antibiotics are not routinely used in the initial treatment of aspiration pneumonitis because there is no evidence that they decrease the incidence of pulmonary infection or alter outcomes. They may be considered if a patient remains symptomatic after 48 hours and has positive culture results, indicating a secondary bacterial infection.
E-cigarette Vaping Associated Lung Injury (EVALI) is commonly associated with the inhalation of which substance?
A) Alcohol
B) Tetrahydrocannabinol (THC)
C) Caffeine
D) Salbutamol
Correct Answer: B) Tetrahydrocannabinol (THC)
Rationale: EVALI has been associated with additives in vaping products, most notably tetrahydrocannabinol (THC), vitamin E acetate, and other oils. These substances have been implicated in causing lung injury among e-cigarette users.
Which group of symptoms is commonly observed in patients with EVALI?
A) Joint pain, rash, and weight loss
B) Dyspnea, cough, and chest pain
C) Hypertension, bradycardia, and hyperglycemia
D) Diarrhea, jaundice, and hallucinations
Correct Answer: B) Dyspnea, cough, and chest pain
Rationale: The typical symptoms of EVALI include respiratory symptoms such as dyspnea, cough, and chest pain. Patients may also experience systemic symptoms like nausea, vomiting, diarrhea, abdominal pain, and fever. Pt may be febrile, tachycardia, tachypnea, and hypoxic
The radiologic findings in EVALI are similar to those seen in which other pulmonary condition?
A) Pulmonary embolism
B) Pneumonia
C) Acute Respiratory Distress Syndrome (ARDS)
D) Chronic Obstructive Pulmonary Disease (COPD)
Correct Answer: C) Acute Respiratory Distress Syndrome (ARDS)
Rationale: Radiologic findings in EVALI often resemble the diffuse alveolar damage seen in ARDS, which includes bilateral opacities on imaging studies without evidence of cardiac failure or fluid overload.
What is the mainstay of treatment for EVALI?
A) Antifungal medication and chest physiotherapy
B) Antibiotics, systemic steroids, and supportive care
C) Antiviral therapy and supplemental oxygen
D) Immediate cessation of vaping and bronchodilators
Correct Answer: B) Antibiotics, systemic steroids, and supportive care
Rationale: The treatment for EVALI typically includes the administration of antibiotics to cover potential secondary bacterial infection, systemic steroids to reduce inflammation, and supportive care, which may include oxygen therapy, mechanical ventilation, and management of associated symptoms.
What clinical presentation might warrant the consideration of antibiotics in the management of EVALI?
A) The patient has a history of vaping THC-containing products.
B) The patient demonstrates systemic symptoms such as fever or tachycardia.
C) Radiographic findings show clear signs of lung injury.
D) The patient does not respond to standard bronchodilator treatment.
Correct Answer: B) The patient demonstrates systemic symptoms such as fever or tachycardia.
Rationale: While there is no direct evidence that antibiotics decrease the incidence of pulmonary infection or alter outcomes in EVALI, they may be considered if the patient presents with systemic symptoms such as fever or tachycardia, which could indicate a possible bacterial superinfection.
What long-term pulmonary sequelae can survivors of severe COVID-19 experience?
A) Transient bronchospasm and increased mucous production
B) Persistent inflammatory interstitial lung disease
C) Immediate recovery of lung function post-infection
D) Increased susceptibility to bacterial pneumonia only
Correct Answer: B) Persistent inflammatory interstitial lung disease
Rationale: Survivors of severe COVID-19 can experience long-term pulmonary complications, including persistent inflammatory interstitial lung disease, which can manifest as fibrosis and continued respiratory symptoms such as dyspnea.
Which pulmonary function test finding is most commonly reported among COVID-19 survivors with lung involvement?
A) Increased lung compliance
B) Normal diffusion capacity
C) A drop in diffusion capacity
D) Decreased peak expiratory flow rates
Correct Answer: C) A drop in diffusion capacity
Rationale: The most commonly reported pulmonary function test finding among COVID-19 survivors is a drop in diffusion capacity, which reflects the severity of initial disease and possible damage to the alveolar-capillary membrane.
Patients who have required what level of care during acute COVID-19 are at the highest risk for long-term pulmonary complications?
A) Outpatient management with oral medications
B) Mechanical ventilation
C) Brief hospitalization without oxygen therapy
D) Inhaled corticosteroid therapy
Correct Answer: B) Mechanical ventilation
Rationale: Patients who have needed mechanical ventilation during their acute COVID-19 illness are at the highest risk for developing long-term pulmonary complications, due to the severity of their respiratory involvement.
What are common findings and imaging studies such as CT scans in survivors of severe COVID-19?
A) Clear lungs with no residual changes but decreased exercise capacity
B) Decreased exercise capacity, hypoxia, and opacities
C) Enlarged cardiac silhouette and pleural effusions w/ rapid shallow breathing
D) Bronchial wall thickening and tree-in-bud patterns and increased PVR
Correct Answer: B) Decreased exercise capacity, hypoxia, and opacities
Rationale: CT scans of COVID-19 survivors often show residual opacities indicative of inflammation or fibrosis, along with clinical findings of decreased exercise capacity and hypoxia, which align with restrictive lung disease.
What is a direct correlation found in COVID-19 survivors concerning the initial disease process?
A) The severity of initial symptoms correlates with the speed of recovery.
B) There is no correlation between initial disease severity and long-term outcomes.
C) The severity of the initial disease process correlates with a drop in diffusion capacity.
D) The worse the disease, the greater the risk of developing extra-parenchymal lung disease.
Correct Answer: C) The severity of the initial disease process correlates with a drop in diffusion capacity.
Rationale: There is a direct relationship between the severity of the initial COVID-19 disease process and subsequent pulmonary function, where a more severe initial presentation correlates with a greater drop in diffusion capacity, indicative of long-term lung damage.
Acute Respiratory Failure (ARF) is diagnosed when PaO2 is below what threshold?
A) 80 mmHg
B) 70 mmHg
C) 60 mmHg
D) 50 mmHg
Correct Answer: C) 60 mmHg
Rationale: ARF is present when the partial pressure of oxygen (PaO2) is less than 60 mmHg despite oxygen supplementation and in the absence of a right-to-left intracardiac shunt.
A PaCO2 greater than what value, in the absence of respiratory-compensated metabolic alkalosis, is consistent with ARF?
A) 40 mmHg
B) 45 mmHg
C) 50 mmHg
D) 55 mmHg
Correct Answer: C) 50 mmHg
Rationale: A PaCO2 greater than 50 mmHg in the absence of respiratory-compensated metabolic alkalosis is consistent with the diagnosis of ARF, indicating hypoventilation and the inability to remove carbon dioxide effectively.
What characterizes acute respiratory failure (ARF) in terms of blood gases?
A) Decreased PaCO2 and increased pH
B) Unchanged PaCO2 and decreased pH
C) Increased PaCO2 and decreased pH
D) Increased PaCO2 and increased pH
Correct Answer: C) Increased PaCO2 and decreased pH
Rationale: ARF is characterized by an abrupt increase in PaCO2 and a decrease in pH, reflecting respiratory acidosis due to acute impairment of ventilation.
In chronic respiratory failure, the PaCO2 and pH levels demonstrate what relationship?
A) PaCO2 decreased, pH increased
B) PaCO2 increased, pH decreased
C) PaCO2 increased, pH normal
D) PaCO2 normal, pH increased
Correct Answer: C) PaCO2 increased, pH normal
Rationale: In chronic respiratory failure, the PaCO2 is increased, but the pH is normal. This indicates a chronic process where the kidneys have had time to compensate for the respiratory acidosis by increasing bicarbonate, thereby normalizing the pH.
What are the three treatment goals for acute respiratory failure?
A) Airway stabilization, CO2 retention, and pH normalization
B) Patent airway, correction of hypoxemia, and removal of excess CO2
C) Bronchodilation, fluid administration, and forced diuresis
D) Oxygen administration, nutritional support, and sedation
Correct Answer: B) Patent airway, correction of hypoxemia, and removal of excess CO2
Rationale: The three primary treatment goals for ARF are to ensure a patent airway, correct hypoxemia, and remove excess CO2. These goals are directed at stabilizing the patient’s respiratory status and improving gas exchange.
Oxygen therapy can be delivered via various devices. Which of the following typically provides oxygen concentrations greater than 50%?
A) Nasal cannula (NC)
B) Venturi mask
C) Nonrebreather mask
D) T-piece
These devices seldom provide 02 concentrations >50%, therefore are only helpful in mild to moderate V/Q mismatching
what the slide says but I think C. is actually 60-100% concentration.
Continuous Positive Airway Pressure (CPAP) therapy may be initiated when which criteria are not met?
A) PaO2 exceeds 70 mmHg
B) PaO2 falls below 60 mmHg
C) SpO2 falls below 85%
D) Respiratory rate exceeds 24 breaths per minute
Correct Answer: B) PaO2 falls below 60 mmHg
Rationale: CPAP may be initiated when methods such as oxygen delivery via nasal cannula or masks fail to maintain a PaO2 above 60 mmHg. CPAP helps by increasing lung volumes and reducing shunting.
CPAP has what primary effect on lung physiology?
A) It decreases lung volumes by promoting alveolar collapse.
B) It increases lung volumes by opening collapsed alveoli.
C) It increases right-to-left intrapulmonary shunting.
D) It decreases respiratory drive by hyperoxygenation.
Correct Answer: B) It increases lung volumes by opening collapsed alveoli.
Rationale: CPAP helps to increase lung volumes by delivering continuous positive pressure to the airways, which can help to open collapsed alveoli and improve oxygenation in conditions with V/Q mismatch.
What risk is associated with the use of CPAP via face mask?
A) A reduced risk of hypoxemia
B) An increased risk of aspiration, particularly in patients with nausea and vomiting
C) Decreased intrathoracic pressure
D) An increased risk of pneumothorax
Correct Answer: B) An increased risk of aspiration, particularly in patients with nausea and vomiting
Rationale: CPAP via face mask can increase the risk of aspiration, especially in patients experiencing nausea and vomiting, due to the positive pressure that may force gastric contents into the pharynx and then into the lungs.
Maintaining a PaO2 >60 mmHg is considered adequate because it corresponds to an SpO2 of what percentage?
A) Greater than 95%
B) Greater than 90%
C) 85-90%
D) 80-85%
Correct Answer: B) Greater than 90%
Rationale: Maintaining a PaO2 greater than 60 mmHg is generally considered adequate because it typically corresponds to an oxygen saturation (SpO2) greater than 90%, which ensures sufficient oxygen delivery to the tissues.
In volume-cycled ventilation, what is the primary control variable?
A) Respiratory rate (RR)
B) Oxygen concentration (FiO2)
C) Tidal volume (TV)
D) Positive end-expiratory pressure (PEEP)
Correct Answer: C) Tidal volume (TV)
Rationale: In volume-cycled ventilation, the primary control variable is the tidal volume (TV), which is set to deliver a fixed volume of air with each mechanical breath, regardless of the pressure (dependent variable) needed to deliver that volume.
What does a pressure limit in a volume-cycled ventilation system do?
A) Increases the tidal volume delivered to the patient
B) Decreases the respiratory rate to prevent hyperventilation
C) Prevents excessive airway pressure by stopping the flow of gas
D) Reduces the oxygen concentration in the ventilator circuit
Correct Answer: C) Prevents excessive airway pressure by stopping the flow of gas
Rationale: A pressure limit can be set in volume-cycled ventilation to prevent excessive inflation pressure. When this set limit is reached, the pressure relief valve opens to stop further gas flow, protecting the patient from high airway pressures.
Significant increases in Pulmonary Artery Pressure (PAP) during mechanical ventilation may indicate what conditions?
A) Improvement in lung compliance
B) Successful recruitment of alveoli
C) Worsening pulmonary edema, pneumothorax, or obstruction in the endotracheal tube
D) Proper positioning of the endotracheal tube
Correct Answer: C) Worsening pulmonary edema, pneumothorax, or obstruction in the endotracheal tube
Rationale: Significant increases in PAP can be a sign of worsening pulmonary edema, the presence of a pneumothorax, a kink in the endotracheal tube (ETT), or a mucus plug obstructing the airway. These conditions can lead to increased resistance to ventilation and increased PAP.
What is a disadvantage of volume-cycled ventilation?
A) It does not allow for spontaneous breathing.
B) It provides inconsistent tidal volumes.
C) It cannot compensate for leaks in the delivery system.
D) It always requires a high level of sedation.
Correct Answer: C) It cannot compensate for leaks in the delivery system.
Rationale: A disadvantage of volume-cycled ventilation is the inability to compensate for leaks in the ventilation system. If a leak occurs, the set tidal volume may not be completely delivered to the patient’s lungs, potentially compromising ventilation.
What are the primary modes of volume-cycled ventilation?
A) Continuous Mandatory Ventilation (CMV) and Pressure Support Ventilation (PSV)
B) Assisted/Controlled (A/C) ventilation and Synchronized Intermittent Mandatory Ventilation (SIMV)
C) High-Frequency Oscillatory Ventilation (HFOV) and Bilevel Positive Airway Pressure (BiPAP)
D) Pressure Controlled Ventilation (PCV) and Airway Pressure Release Ventilation (APRV)
Correct Answer: B) Assisted/Controlled (A/C) ventilation and Synchronized Intermittent Mandatory Ventilation (SIMV)
Rationale: The primary modes of volume-cycled ventilation are Assisted/Controlled (A/C) ventilation, where the ventilator fully supports each breath, and Synchronized Intermittent Mandatory Ventilation (SIMV), which allows for spontaneous breathing efforts between the mandatory ventilator-delivered breaths.
In Assisted/Controlled (A/C) ventilation, what triggers the ventilator to deliver a breath if there is no inspiratory effort by the patient?
A) A drop in oxygen saturation
B) The passage of a set time interval
C) A rise in carbon dioxide levels
D) The patient’s heart rate
Correct Answer: B) The passage of a set time interval
Rationale: In A/C ventilation, if the patient does not initiate an inspiratory effort, the ventilator will automatically deliver a breath at a preset rate based on the passage of a set time interval.
What is the primary feature of Synchronized Intermittent Mandatory Ventilation (SIMV)?
A) It allows for spontaneous breathing only at a set respiratory rate.
B) It provides mandatory breaths in synchrony with the patient’s inspiratory efforts.
C) It completely takes over the breathing process without allowing for any patient effort.
D) It synchronizes ventilation with the patient’s heart rate.
Correct Answer: B) It provides mandatory breaths in synchrony with the patient’s inspiratory efforts.
Rationale: SIMV permits spontaneous ventilation (SV) while providing a predefined minute ventilation. The ventilator circuit provides sufficient gas flow and delivers periodic mandatory breaths that are synchronized with the patient’s spontaneous inspiratory efforts.
What are the theoretical advantages of SIMV over A/C ventilation?
A) It increases the work of breathing and prevents respiratory muscle atrophy.
B) It allows for complete control of the patient’s ventilation by the provider.
C) It encourages the use of respiratory muscles, potentially improving patient-ventilator coordination.
D) It provides a higher mean airway pressure for better oxygenation.
Correct Answer: C) It encourages the use of respiratory muscles, potentially improving patient-ventilator coordination.
Rationale: The theoretical advantages of SIMV over A/C include the continued use of respiratory muscles, which may prevent muscle atrophy, lower mean airway and intrathoracic pressure, prevention of respiratory alkalosis, and potentially improved patient-ventilator coordination.
How does pressure-cycled ventilation differ from volume-cycled ventilation?
A) It delivers a fixed tidal volume regardless of the pressure required.
B) It provides gas flow until a preset airway pressure is reached.
C) It is primarily used during the weaning process from mechanical ventilation.
D) It prevents spontaneous breathing efforts by the patient.
Correct Answer: B) It provides gas flow until a preset airway pressure is reached.
Rationale: Pressure-cycled ventilation differs from volume-cycled by delivering gas flow to the lungs until a preset airway pressure is reached. The tidal volume (dependent variable) varies with changes in compliance and airway resistance, and is not fixed as in volume-cycled ventilation.
What is the most important predisposing factor for developing ventilator-associated pneumonia (VAP) in mechanically ventilated patients?
A) Patient immunosuppression
B) Mechanical ventilation itself
C) Intubation
D) The type of mechanical ventilator used
Correct Answer: C) Intubation
Rationale: In mechanically ventilated patients, intubation is the most important predisposing factor for developing nosocomial pneumonia, also known as ventilator-associated pneumonia (VAP). The process of intubation can allow microorganisms to bypass normal upper airway defenses, leading to infection.
The primary cause of ventilator-associated pneumonia (VAP) is attributed to what mechanism?
A) Hematogenous spread of bacteria
B) Airborne transmission to the patient
C) Micro-aspiration of contaminated secretions around the endotracheal tube cuff
D) Direct inoculation during surgical procedures
Correct Answer: C) Micro-aspiration of contaminated secretions around the endotracheal tube cuff
Rationale: VAP is primarily caused by the micro-aspiration of contaminated secretions around the endotracheal tube (ETT) cuff. These secretions can harbor pathogens that may then enter the lower respiratory tract and cause infection.
