Lung Stuff

Question 1

Positive pressure ventilation improves gas exchange but poses the risk of

Answer 1

pneumothorax

Question 2

Acute pancreatitis causes respiratory failure likely due to ___

Answer 2

acute respiratory distress syndrome

Question 3

Mechanical ventilation administered Tidal Volumes should be about __ mL/kg of pt’s ideal body weight

Answer 3

6

Question 4

Increasing the ____ in mechanical ventilation increases ventilation and will worsen any current respiratory alkalosis

Answer 4

tidal volume/respiratory rate

Question 5

Chest physiotherapy is utilized in patients with __ or ___ to loosen and promote expectoration of secretions.

Answer 5

pneumonia or atelectasis

*Bronchiectasis require long-term chest physiotherapy.

Question 6

In Mechanical Ventilation
PaO2 is influenced mainly by __ & __

Answer 6

FiO2 & PEEP

Question 7

In Mechanical Ventilation

PaCO2 is determined mainly by __ & __

Answer 7

respiratory rate

tidal volume

Question 8

In ARDS with mechanical ventilation

a certain degree of PEEP (usually ≥ __cm H2O) is needed to recruit collapsed alveoli

Answer 8

10

Question 9

In ARDS with mechanical ventilation

As FiO2 is lowered, a compensatory increase in __may be required

Answer 9

PEEP

Question 10

In ARDS with mechanical ventilation

____ prevents alveolar over-distension of lungs to inhibit further lung injury and improve mortality in ARDS.

Answer 10

Lower tidal volumes

Question 11

In ARDS with mechanical ventilation

A mild ___ is acceptable to enable low tidal volumes

Answer 11

hypercapnic respiratory acidosis

“permissive hypercapnia”

Question 12

In ARDS with mechanical ventilation

The goal PaO2 is ___ mm Hg, corresponding to an oxygen saturation of ___%.

Immediately following intubation, a high FiO2 ( ≥ __%) is needed then is adjusted as ABG results return.

Answer 12

60-90

92%-96%

60% (0.6)

Question 13

Correction of the hypercapnia (Respiratory Acidosis) requires increased ventilation, which can be accomplished via increased __ or __

Answer 13

respiratory rate

tidal volume

Question 14

Acute respiratory distress syndrome involves acute pulmonary edema and is diagnosed by hypoxemia and _____ that are not explained by cardiac dysfunction or volume overload.

Answer 14

bilateral alveolar infiltrates

Question 15

ARDS leads to pulmonary edema, decreased lung ___, and acute pulmonary ___.

Answer 15

compliance

hypertension

(increased A-a gradient)

Question 16

A _____ decreases pulmonary edema risk and accelerates recovery from ARDS.

Answer 16

negative fluid balance

Question 17

PEEP is calculated with the end-___ hold maneuver

Answer 17

expiratory

Question 18

Right main-stem bronchus intubation

causing atelectasis of L lung & absent breath sounds can be distinguished from Pneumothorax by the ABSENCE of ____

Answer 18

Hypotension

Question 19

__ & __ can lead to ARDS

Answer 19

Acute Pancreatitis

Sepsis

Question 20

ARDS
PaO2/FiO2 =
(P:F)

Answer 20

(P:F) 300 or LESS

Question 21

ARDS is pulmonary edema that is not ___ in etiology

Answer 21

cardiogenic

Question 22

what setting recruits collapsed alveoli

Answer 22

PEEP

Question 23

In ARDS to increase PaO2 what parameter is changed

Answer 23

increase PEEP

Question 24

In ARDS how do we prevent lung injury on ventilation (what parameter is changed)

Answer 24

Keep low tidal volumes
(6 mL/kg of pt’s ideal body weight)

Careful not to drive RR up thus worsening ventilation

Question 25

Acute massive PE presents with (3)
pleuritic chest pain
tachycardia

Answer 25

hypotension
JVD
new RBBB

Question 26

PE suspected next best step?

Answer 26

calculate Wells score

Question 27

PE Wells score 4 or less next best step?

Answer 27

D-dimer

Question 28

PE wells score 5+ next best step?

Answer 28

Anti-coagulate (if no contraindications)
and
get a CT spiral (if contraindicated get V/Q scan)

Question 29

Pulmonary embolism causes what acid base disorder?

Answer 29

Respiratory alkalosis

2/2 hyperventilation

Question 30

What is a rare but specific finding on ECG for PE?

Answer 30

S (I)
Q (III)
T (III) - inverted

Question 31

DVT unlikely, but D-dimer greater than 500, next best step?

Answer 31

Compression ultrasonography

Question 32

DVT wells score criteria

how many points for likely vs not likely?

Answer 32

Active/or treated cancer within last 6months (1)
Unilateral leg swelling (1)
Varicose veins visible (1)
Tenderness along swollen leg (1)
recent hx of immobilization or surgery (1)
history of DVT (1)

<2 DVT unlikely = D-dimer
2+ DVT likely = Compression ultrasonography (if neg gt D-dimer)

Question 33

DVT likely what is the next best step?

Answer 33

Compression ultrasonography

Question 34

Treatment for Acute PE?

Treatment for history of PE?

Answer 34

Anticoagulation (Heparin)

Chronic
Apixiban (DOAC) or Warfarin or Enoxaparin (LMWH)

Question 35

When is thrombolysis indicated in PE?

Answer 35

Massive PE causing
RH failure
Hemodynamic instability