Patho Quiz 6 (BP, Shock, Respiratory)

Question 1

What does an “A-line” measure?

Answer 1

“A-lines” or arterial lines measure blood pressure constantly by means of a catheter inserted into an artery.

Question 2

What are long-term regulations of systemic BP that the body utilizes?

Answer 2

Extracellular fluid, RAAS, SNS, Na+ regulation, Natriuretic hormones, circulating enzymes and peptides

Question 3

What is the cause of primary HTN?

Answer 3

Primary HTN is idiopathic in nature (no known cause).

Question 4

HTN is an independent risk factor for __ , ___ , ___ (3).

Answer 4

Renal failure, CVA, CAD

Question 5

High blood pressure increases the workload of the left ventricle because it increases what?

Answer 5

Afterload.

Question 6

What is the first line medication class to combat primary HTN?

Answer 6

Thiazide diuretics (ACEI, ARBs, BBs, CCBs may be used in combination).

Question 7

What are the causes of secondary HTN? (6)

Answer 7

Renal disease, pregnancy, obesity/sleep apnea, endocrine disorders, coarctation of the heart (congenital heart defect)

Question 8

What is the goal in treating a hypertensive emergency?

Answer 8

Get MAP down by 25% in 1 hour with IV drugs.

Question 9

What qualifies as a HTN emergency?

Answer 9

Sudden increase in either or both systolic or diastolic blood pressure with evidence of end-organ damage

Question 10

What is a common cause of orthostatic hypotension?

Answer 10

Volume depletion (dehydration).

Question 11

What is true of HTN urgency?

Answer 11

Exceedingly high BP levels are present–will not be treated aggressively.

Question 12

Shock is defined by what?

Answer 12

Tissue perfusion (NOT BP).

Question 13

Which signs do all three types of shock share (cardiogenic, hypovolemic, and septic)?

Answer 13

Hypotension and low urine output.

Question 14

What the signs of shock? (7)

Answer 14

• Narrowed pulse pressure
• Tachycardia
• Hyperventilation
• Decreased urine output
• Cool, clammy skin
• ALOC
• Dilated pupils

Question 15

How does the body compensate during shock? (3)

Answer 15

• Increased vascular resistance
• Increased HR
• Increased force of contraction

Question 16

What occurs during the progressive stage of shock?

Answer 16

Oxygen-free radicals (chemical disruption involving Oxygen molecule float around in blood stream), release of inflammatory cytokines, and activation of the clotting cascade system.

Question 17

What are the common causes of obstructive shock? (3)

Answer 17

Pulmonary embolism, cardiac tamponade, and tension pneumothorax.

Question 18

Define sepsis

Answer 18

An inflammatory response to widespread infection

Question 19

Name and describe the stages of septic shock

Answer 19

• Initial Phase (Hyperdynamic): warm stage-shunting of blood to core
• Progressive Phase (Hypodynamic): cold stage-BP and CO drop

Question 20

What are the four criteria to indicate Systemic Inflammatory Response Syndrome (SIRS)?

Answer 20

• HR>90
• RR>20
• WBC below 4,000 or above 12,000
• Temp less than 36 or above 38 C

Question 21

What are complications of shock? (4)

Answer 21

• Acute Respiratory Distress Syndrome (ARDS)
• Disseminated Intravascular Coagulation (DIC)
• Acute Kidney Injury
• Multiple Organ Dysfunction Syndrome (MODS)

Question 22

What is the rationale for the appearance of a rapid heart rate in shock?

Answer 22

SNS stimulation

Question 23

Neurogenic shock is a result of ______.

Answer 23

Loss of sympathetic activation of arteriolar smooth muscle, caused by medullary depression (brain injury, drug overdose) or lesions of sympathetic nerve fibers (spinal cord injury)

Question 24

Where does gas exchange occur?

Answer 24

Terminal bronchioles and alveoli.

Question 25

What is the role of surfactant?

Answer 25

Keeps alveoli from collapsing on itself and causing atelectesis.

Question 26

What is dead space?

Answer 26

Volume of air filling lung which is not involved in gas exchange.

Question 27

What is the ratio of tidal volume v. total lung volume?

Answer 27

500 mL : 6 L

Question 28

What are the three types of dead space?

Answer 28

Anatomic (everyone has some), alveolar, physiologic

Question 29

What is the difference between PAO2 and PaO2?

Answer 29

PAO2: amount of Oxygen entering the the alveoli PaO2: amount of Oxygen leaving the alveoli and going into the arteries

Question 30

What do the central chemoreceptors in the medulla respond to to regulate the respiratory system?

Answer 30

PaCO2 and decrease in pH

Question 31

What do the peripheral chemoreceptors in the aortic arch and carotid bodies respond to to regulate the respiratory system?

Answer 31

PaO2 and decrease in pH

Question 32

What is the ideal ventilation : perfusion ratio?

Answer 32

0.8

Question 33

What are the characteristics of a pulmonary embolus with regards to V/Q mismatch?

Answer 33

Ventilation without perfusion

Question 34

What are the four ways CO2 are transported?

Answer 34

- Dissolved in plasma - As carbonic acid in the plasma - As bicarbonate - As carbamino compounds on the hemoglobin molecule

Question 35

Define hypoventilation

Answer 35

Air is insufficient to provide O2 and remove CO2, results in increased PaCO2

Question 36

Define hyperventilation

Answer 36

Increase of air entering the alveoli leads to hypocapnia (reduced CO2 in blood)

Question 37

What are the four categories of hypoxia?

Answer 37

- Hypoxic hypoxia (high altitude) - Anemia hypoxia (low hemoglobin) - Circulatory hypoxia (low CO, shock) - Histologic hypoxia (poisoning)

Question 38

Define acute respiratory failure

Answer 38

State of disturbed gas exchange resulting in low PaO2 (<60) and PaCO2 >50 with a pH less than 7.30, when the pt. is breathing room air

Question 39

What is a PaO2 goal during respiratory failure?

Answer 39

>60 mmHg

Question 40

What is Virchow's Triad and when does it occur?

Answer 40

Occurs during VTE (DVT, PE) - Venous stasis - Hypercoagulability - Intimal wall injury

Question 41

What is the difference between the two types of asthma?

Answer 41

- Intrinsic (non-allergic): develops in middle age, repetitive respiratory infections - Extrinsic (IgE-mediated): develops in children, allergic rhinitis, family history

Question 42

What is the difference between symptoms of a minor asthma attack v. a severe attack?

Answer 42

Minor: Wheezing on EXHALATION Severe: Wheezing on INHALATION

Question 43

Define chronic bronchitis

Answer 43

Chronic or recurrent productive cough >3 months over 2+ successive years with hypersecretion of bronchial mucus.

Question 44

Define Cor Pulmonale

Answer 44

Right sided HF as a result of pulmonary diseases

Question 45

What is one of the treatments used in chronic bronchitis (especially in younger patients)?

Answer 45

Theophylline (liquid caffeine) which causes bronchodilation and vasoconstriction

Question 46

What virus can lead to bronchiolitis in children?

Answer 46

RSV

Question 47

What is the end treatment goal for CF patients?

Answer 47

Lung transplant

Question 48

What is the most dangerous complication of epiglottitis?

Answer 48

Complete airway obstruction (closes off top off trachea)

Question 49

What are the cardinal symptoms of Croup?

Answer 49

Barking cough with inspiratory stridor

Question 50

A pulmonary assessment that reflects increased resistance to airflow due to narrowing, or internal or external obstruction of the passages would cause:

Answer 50

Decreased forced expiratory volume

Question 51

What does SOB, coarse breath sounds, and a productive cough likely indicate?

Answer 51

Chronic bronchititis

Question 52

What is a common finding of Acute Respiratory Distress Syndrome (ARDS)?

Answer 52

Severe hypoxemia caused by intrapulmonary right-to-left shunting of blood

Question 53

What is the cause of Infant Respiratory Distress Syndrome?

Answer 53

They do not yet produce surfactant (premie babies)

Question 54

How can Bronchitis and Pneumonia be differentiated?

Answer 54

Through a chest X-RAY (Pneumonia will show up, Bronchitis won't)

Question 55

Pneumonia can occur in what parts of the body?

Answer 55

Lungs, brain, liver, spinal cord, etc.