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Pulmonology > Oxygen & Perfusion Disorders > Flashcards

Oxygen & Perfusion Disorders Flashcards

1
Q

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

A

PO2 under 60 mmHg, and PCO2 over 50 mmHg

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2
Q

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

A

Dyspnea and HA

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3
Q

What is the pathophysiology behind “pickwickian” syndrome?

A

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

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4
Q

How do you treat obesity-hypoventilation syndrome?

A

weight loss

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5
Q

imaging finding indicative of ARDS?

A

Air bronchogram

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6
Q

Chief symptom of hypoxemia?

A

dyspnea

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7
Q

Signs of hypoxemia?

A

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

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8
Q

Signs of hypercapnia?

A

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

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9
Q

What are risk factors for development of acute respiratory failure?

A

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

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10
Q

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

A

ensure adequate oxygenation of vital organs.

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11
Q

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

A

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

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12
Q

How do you treat ARF via ventilatory methods?

A

via face mask (noninvasive) or

tracheal intubation

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13
Q

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

A

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

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14
Q

What is a common side effect of overinflation?

A

acute respiratory alkalosis

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15
Q

What is a serious complication of mechanical ventilation?

A

Ventilator- associated pneumonia

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16
Q

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

A

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

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17
Q

How does ARDS differ from respiratory failure?

A

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

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18
Q

Risk factors for ARDS?

A

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

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19
Q

What is a common etiology of ARDS?

A

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.

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20
Q

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

A

TRUE!

21
Q

How can you prevent ARDS?

A

you can’t :(

22
Q

Treatment of the hypoxemia usually requires:

A

tracheal intubation and positive-pressure ventilation

23
Q

Which body position may help oxygenation in ARDS patients?

A

prone

24
Q

ARDS + sepsis = what mortality rate?

A

90%

25
Q

What are the lasting effects on ARDS survivors?

A

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

26
Q

Most patients with obesity-hypoventilation syndrome also suffer from:

A

Obstructive sleep apnea, this must be treated aggressively

27
Q

How does hyperventilation affect CO2 levels?

A

DECREASE (hypocapnia)

28
Q

How is chronic hyperventilation diagnosed?

A

if symptoms are reproduced during voluntary hyperventilation

29
Q

How does acute hyperventilation present?

A

hyperpnea, paresthesias, carpopedal spasm, tetany, and anxiety

30
Q

How can you treat hyperventilation in the office?

A

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

31
Q

What value of systolic pulmonary pressure is considered hypertensive?

A

> 30 mm Hg (normal is 25/15)

32
Q

Most common cause of pulmonary HTN?

A

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

33
Q

What lung conditions can cause pulmonary HTN?

A

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

34
Q

Which demographic is Pulm HTN most commonly seen in?

A

women around 50 years

35
Q

What is the most common symptom of Pulm HTN?

A

PROGRESSIVELY worsening SOB on exertion. Sometimes syncope on exertion

36
Q

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

A

True!

37
Q

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

A

right-sided catherization

38
Q

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

A

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

39
Q

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

A

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

40
Q

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

A

WEINER drugs!! Viagra, cialis ;)

41
Q

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

A

TRUE

42
Q

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

A

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

43
Q

Acute pulmonary edema presents characteristically like:

A

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

44
Q

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

A

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

45
Q

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

A

obese, middle-aged men

46
Q

What are the first steps in management of OSA?

A

weight loss and strict avoidance of alcohol and hypnotic drugs

47
Q

How do you diagnose OSA?

A

polysomnography

48
Q

What labs should be run with suspected OSA patients?

A

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

Pulmonology (17 decks)

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