Oxygen & Perfusion Disorders

Question 1

Acute respiratory failure is defined by what PO2 and PCO2 levels?

Answer 1

PO2 under 60 mmHg, and PCO2 over 50 mmHg

Question 2

What are hallmark SX of hypercapnia (high levels of CO2)?

Answer 2

Dyspnea and HA

Question 3

What is the pathophysiology behind “pickwickian” syndrome?

Answer 3

aka obesity hypoventilation syndrome -> pts who are obese may blunt their ventilation drive & increase the mechanical load on the chest (due to weight)

Question 4

How do you treat obesity-hypoventilation syndrome?

Answer 4

weight loss

Question 5

imaging finding indicative of ARDS?

Answer 5

Air bronchogram

Question 6

Chief symptom of hypoxemia?

Answer 6

dyspnea

Question 7

Signs of hypoxemia?

Answer 7

cyanosis, restlessness, confusion, anxiety, delirium, tachypnea, bradycardia or tachycardia, hypertension, cardiac dysrhythmias, and tremor

Question 8

Signs of hypercapnia?

Answer 8

peripheral and conjunctival hyperemia, hypertension, tachycardia, tachypnea, impaired consciousness, papilledema, and asterixis (tremor of hand when wrist is extended).

Question 9

What are risk factors for development of acute respiratory failure?

Answer 9

smoking, drinking, family hx of respiratory disease, lung cancer, COPD

Question 10

What is the main therapeutic goal in acute hypoxemic respiratory failure?

Answer 10

ensure adequate oxygenation of vital organs.

Question 11

How do you treat acute respiratory failure via non-ventilatory methods?

Answer 11

With nasal cannula of inspired oxygen. Higher concentrations may be needed with ARDS, pneumonia, parenchymal lung disease patients

Question 12

How do you treat ARF via ventilatory methods?

Answer 12

via face mask (noninvasive) or

tracheal intubation

Question 13

What is first line therapy in COPD patients with hypercapnic respiratory failure that have a patent airway?

Answer 13

NPPV (non invasive positive pressure ventilation) via full face mask or nasal mask

Question 14

What is a common side effect of overinflation?

Answer 14

acute respiratory alkalosis

Question 15

What is a serious complication of mechanical ventilation?

Answer 15

Ventilator- associated pneumonia

Question 16

What do you need to take into consideration when feeding a patient in respiratory failure?

Answer 16

Overfeeding, especially with CHO-rich formulas, should be avoided, because it can increase hypercapnia

Question 17

How does ARDS differ from respiratory failure?

Answer 17

ARDS is acute failure within 1 week of a systemic or pulmonary insult w/o evidence of HF.

Question 18

Risk factors for ARDS?

Answer 18

sepsis, aspiration of gastric contents, shock, infection, lung contusion, nonthoracic trauma, toxic inhalation, near-drowning, multiple blood transfusions.

Question 19

What is a common etiology of ARDS?

Answer 19

damage to endothelial cells and alveolar epithelial cells causes increased vascular permeability and decreased activity and production of SURFACTANT –> leads to pulmonary edema, alveolar collapse, and hypoxemia.

Question 20

T/F. ARDS can precipitate multi organ failure (kidneys, liver, gut, CNS, CV)

Answer 20

TRUE!

Question 21

How can you prevent ARDS?

Answer 21

you can’t :(

Question 22

Treatment of the hypoxemia usually requires:

Answer 22

tracheal intubation and positive-pressure ventilation

Question 23

Which body position may help oxygenation in ARDS patients?

Answer 23

prone

Question 24

ARDS + sepsis = what mortality rate?

Answer 24

90%

Question 25

What are the lasting effects on ARDS survivors?

Answer 25

cough, dyspnea, sputum production - tend to improve over time.

Question 26

Most patients with obesity-hypoventilation syndrome also suffer from:

Answer 26

Obstructive sleep apnea, this must be treated aggressively

Question 27

How does hyperventilation affect CO2 levels?

Answer 27

DECREASE (hypocapnia)

Question 28

How is chronic hyperventilation diagnosed?

Answer 28

if symptoms are reproduced during voluntary hyperventilation

Question 29

How does acute hyperventilation present?

Answer 29

hyperpnea, paresthesias, carpopedal spasm, tetany, and anxiety

Question 30

How can you treat hyperventilation in the office?

Answer 30

pursed lip breathing, or through the nose with one nostril pinched, or rebreathing expired gas from a paper bag

Question 31

What value of systolic pulmonary pressure is considered hypertensive?

Answer 31

>30 mm Hg (normal is 25/15)

Question 32

Most common cause of pulmonary HTN?

Answer 32

Heart failure (left --> right) (group 2)

Question 33

What lung conditions can cause pulmonary HTN?

Answer 33

COPD, sleep apnea, thromboembolism, interstitial lung disease, pulmonary fibrosis, bronchiectasis (group 3)

Question 34

Which demographic is Pulm HTN most commonly seen in?

Answer 34

women around 50 years

Question 35

What is the most common symptom of Pulm HTN?

Answer 35

PROGRESSIVELY worsening SOB on exertion. Sometimes syncope on exertion

Question 36

T/F: chest imaging and PFTs are useful in determining the cause of pulm HTN in group 3.

Answer 36

True!

Question 37

What is the gold standard for diagnosis and quantification of pulm HTN?

Answer 37

right-sided catherization

Question 38

Patient has unexplained pulm HTN and a hx of PE or risk factors for PE, what should be done?

Answer 38

Need to rule out PE/thromboembolic disease. V/Q lung scanning is sensitive test that differentiate this.

Question 39

T/F. Patients with group 3 pulm HTN should be receiving supplemental oxygen.

Answer 39

TRUE if hypoxic at rest or with physical activity. If have COPD need to supplement for >15 hrs/day.

Question 40

Which non-pulmonary drugs are approved by the FDA to treat pulm HTN?

Answer 40

WEINER drugs!! Viagra, cialis ;)

Question 41

T/F. The presence of cor pulmonale carries a poor survival outcome regardless of the cause of pulm HTN,

Answer 41

TRUE

Question 42

Cor pulmonale usually responds to measures that reduce pulmonary artery pressure, such as:

Answer 42

supp oxygen, correct acidemia, bed rest, salt restriction, diuretics

Question 43

Acute pulmonary edema presents characteristically like:

Answer 43

severe dyspnea, production of PINK FROTHY SPUTUM, and diaphoresis and cyanosis. RALES in all lung fields

Question 44

What are some physical or social aspects that can make a person more prone to sleep apnea?

Answer 44

narrowed upper airways, ingestion of alcohol or sedatives before sleep, common cold, hypothyroidism and cigarette smoking are additional risk factors.

Question 45

What is the common demographic for patients with obstructive sleep apnea/

Answer 45

obese, middle-aged men

Question 46

What are the first steps in management of OSA?

Answer 46

weight loss and strict avoidance of alcohol and hypnotic drugs

Question 47

How do you diagnose OSA?

Answer 47

polysomnography

Question 48

What labs should be run with suspected OSA patients?

Answer 48

thyroid function tests (TSH, T4, serum) - need to exclude hypothyroidism