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Acute Care PNP Exam > Pulmonary Review > Flashcards

Pulmonary Review Flashcards

1
Q

All lung disorders cause some kind of airway ______?

A

Obstruction

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2
Q

Describe a complete airway obstruction

A

no airflow

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3
Q

Describe a partial airway obstruction

A

Impaired airflow

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4
Q

Disease examples of upper airway respiratory distress?

A

Epiglottitis, obstructive sleep apnea, tracheomalacia

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5
Q

Disease examples of lower airway respiratory distress?

A 
Pneumonia
Asthma
Acute respiratory distress syndrome
Pneumothorax
Cystic FIbrosis
Atelectasis
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6
Q

Most common respiratory disorder in daycare and preschool children?

A

Common cold

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7
Q

Presents with low-grade fever, rhinitis, and usually resolves by day 10

A

Common cold

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8
Q

Most common “common cold” viruses

A

Parainfluenza
RSV
Coronavirus
Human metapneumovirus

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9
Q

Presents with inflammation of mucosal lining of throat, acute presentation with erythema, exudate, ulceration

A

Pharnygitis

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10
Q

Presents with pain, myalgia/arhralgia, fever, sore throat/dysphagia, rhinitis, cough, hoarseness, stomatitis, gradual onset

A

Viral Pharyngitis

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11
Q

Which pharyngitis presents with exudate on tonsils, soft palate?

A

EBV viral pharyngitis

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12
Q

Which pharyngitis presents with follicular pattern on pharynx?

A

Adenovirus viral pharyngitis

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13
Q

Which pharyngitis presents with vesicles/ulcers on tonsils?

A

Enterovirus viral pharyngitis

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14
Q

Which pharyngitis presents with ulcers anteriorly/marked adenopathy?

A

HSV viral pharyngitis

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15
Q

Which pharyngitis presents with more lower tract disease?

A

Parainfluenza/RSV viral pharyngitis

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16
Q

Presents with petechiae on soft palate/pharynx, swollen, beefy-red uvula/tonsillopharyngeal tissue

Yellow, blood-tinged exudate

Tender, enlarged anterior cervical lymph nodes

Bad breath
Scarlatiniform rash, strawberry tongue, circumoral pallor if scarlet fever

A

Acute Bacterial Pharyngitis

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17
Q

Commonly occurs in late winter/early spring in ages 5 to 14 years old

A

Acute Bacterial Pharyngitis

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18
Q

Treatment for acute bacterial pharyngitis?

A

Antibiotics in symptomatic child with +RADT or culture
Supportive care
NO STEROIDS
Return to school when on antibiotics after 24 hours

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19
Q

After recent bacterial pharyngitis, the patient is presenting with a new tic disorder and some obsessive thoughts. Which complication does this patient have?

A

Pediatric autoimmune neuropsychiatric disorder syndrome (PANDAS)

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20
Q

Does PANDAS have acute or graduate onset?

A

Abrupt onset

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21
Q

What the common age group for PANDAS complication after acute bacterial pharyngitis?

A

Prepubertal onset

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22
Q

Acute presentation of high fever, purulent nasal discharge with worsening URI symptoms, headache, bad breath, fatigue, facial pain, congestion/fullness,nasal discharge, purulence/discolroed postnatal drip

A

Rhinosinusitis

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23
Q

What are the criteria for antibiotics for rhinosinusitis?

A

URI lasting more than 10 days with purulent discharge, cough/worsening fever, high fever

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24
Q

Brassy cough, stridor, hoarseness, respiratory distress

A

Croup

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25
Q

Mild to severe laryngeal obstruction and stridor with symptoms worse at night

A

Croup

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26
Q

Presents with slight dyspnea, tachypnea, retractions, mild, brassy/barky cough, stridor, low grade to high fever, epiglottis is normal, substernal retractions, prolonged inspiration, wheezing/rales

A

Croup

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27
Q

What will radiograph show for croup?

A

Subglottis narrowing “steeple sign”

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28
Q

What is the common management for croup?

A 
Humidified air
Nebulized epinephrine
Corticosteroids
Bronchodilators if bronchospasm present
Heliox for severe croup
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29
Q

A patient presents in the ER with croup and has a fever greater than 102.2F. Should the patient be sent home with supportive care or admitted?

A

Hospitalization

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30
Q

A patient presents in the ER with croup and has a respiratory rate of 88 bpm. Should the patient be sent home with supportive care or admitted?

A

Hospitalization

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31
Q

What is the common age for epiglottitis?

A

1-5 years old

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32
Q

Presentation of abrupt onset of fever, severe sore throat, dyspnea, inspiratory distress without stridor, drooling

A

Epiglottitis

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33
Q

There is a 4 year old male presenting to the ER with drooling and severe retractions. He feels some relief with hyperextending his neck.

A

Epiglottitis

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34
Q

What will the radiograph show for epiglottitis?

A

“Thumb sign”

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35
Q

What is the best prevention for epiglottitis?

A

HIB immunization

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36
Q

Inflammation, necrosis, edema of respiratory epithelial cells in small airways

A

Bronchiolitis

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37
Q

Presents with URI symptoms, gradual development of respiratory distress, low to moderate fever, decreased appetite, tachypnea, retractions, expiratory wheezing, fine/coarse crackles

A

Bronchiolitis

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38
Q

What is the recommended treatment for bronchiolitis?

A

Hydration and antipyretics
Monitor fluid intake
Nasal suctioning

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39
Q

What is not recommended treatment for bronchiolitis?

A

No bronchodilators
No antibiotics
No deep airway suctioning

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40
Q

Presentation of rapid onset of hoarseness or chronic croupy cough along with unilateral wheezing and recurrent pneumonia

A

Foreign body aspiration

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41
Q

Which side of the lung is commonly affected with foreign body aspiration?

A

Right lung

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42
Q

A three year old girl presents with blood-streaked sputum and had initially coughing, gagging, and choking. What is likely her diagnosis?

A

Foreign body aspiration

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43
Q

Presentation of dry, hacking cough, low substernal discomfort, burning chest pain

A

Bronchitis

44
Q

There is coarse breath sounds, rhonchi, rales on exam

A

Bronchitis

45
Q

What is not recommended for bronchitis treatment?

A

Cough suppressants

Bronchodilators

46
Q

Presents with tachycardia, nasal flaring, grunting, retractions, tachypnea, air hunger, cyanosis, fine crackles, dullness, diminished breath sounds

47
Q

What are the common signs of bacterial pneumonia?

A

Fever, hypoxia, lethargy
Splinting affected side, tachypnea, retractions
Pleural effusion

48
Q

What are the common signs of viral pneumonia?

A

Wheezing

Repetitive, staccato cough

49
Q

What is the common treatment for pneumonia?

A

Antipyretics
Hydration
Rest

50
Q

Genetic disorder with chronic obstructive pulmonary disease, GI disturbances, exocrine dysfunction

A

Cystic fibrosis

51
Q

What is the genetic inheritance of cystic fibrosis?

A

Autosomal recessive

52
Q

Common GI issues with cystic fibrosis

A

Meconium ileus, pancreatic insufficiency, rectal prolapse
Thick, fat-laden stools, failure to thrive
Volvulus, duodenal inflammation, GER< AKED deficiencies
Distal intestinal obstructive syndrome

53
Q

Chronic respiratory disease characterized by periods of coughing, wheezing, respiratory distress, bronchospasm

54
Q

What is the asthma triad?

A

Mucus, inflammation, bronchoconstriction

55
Q

What is the most common cause of respiratory alkalosis?

A

Hyperventilation

56
Q

What is the most common cause of respiratory acidosis?

A

Retention of CO2 from hypoventilation

57
Q

What is the most common cause of metabolic acidosis?

A

Added acid or lost base

58
Q

What is the most common cause of metabolic alkalosis?

A

Added base or lost acid

59
Q

What are common examples of respiratory alkalosis causes?

A 
Anxiety, pain
fever
Stimulants
CNS irritations
Excessive ventilatory support
60
Q

What are the common example of respiratory acidosis causes?

A

CNS depression, neuromuscular disease, trauma, restrictive lung disease, COPD

61
Q

What are the common examples of metabolic acidosis causes?

A

DKA
Renal disease
Lactic Acidosis
Diarrhea, intestinal fluid loss

62
Q

What are the common examples of metabolic alkalosis causes?

A

Bicarb, citrate, too much Tums

vomiting, NG suction, low potassium or chloride, diuretics

63
Q

What Mallampati classification is this: faucial pillars, soft and hard palates, uvula visualized

64
Q

What Mallampati classification is this: faucial pillars, soft and hard palates visualized; uvula partially masked by base of tongue

65
Q

What Mallampati classification is this: only soft and hard palates visualized; can possibly see base of uvula

66
Q

What Mallampati classification is this: only hard palate visualized

67
Q

Chest radiography shows bilateral infiltrates. Which pulmonary disease process is occuring?

A

Acute Respiratory Distress Syndrome

68
Q

What are the respiratory settings recommended for ARDS?

A

High PEEP, low tidal volume
Avoid PIP above 30

Permissive hypercapnia (high Co2)

69
Q

What is a “crunching sound noted over the precordium space that is noted concurrent with heart tones rather than respiration”?

A

Hamman’s sign

70
Q

What does Hamman’s sign sign?

A

Pneumomediastinum

71
Q

A patient has tachycardia, tachypnea, mill wheel murmur, muffled heart sounds, hypotension. What does this signal?

A

Pneumopericardium

72
Q

You take a radiograph of your patient and note radiolucent streaks in the mediastinum. What is happening to your patient?

A

Pneumomediastinum

73
Q

You take a radiograph of your patient and note air in the pericardial sac and “halo” sign. What is happening to your patient?

A

Pneumopericardium

74
Q

You have a 18 year old 6’1 skinny male patient that has a history of vaping. What is he at risk for?

A

Spontaneous pneumothorax

75
Q

What are the risk factors for spontaneous pneumothorax?

A

Tall, thin males ages 10-30 years
Smoking
Underlying lung disease or connective tissue disorder

76
Q

Presents with ipsilateral hyperresonance to percussion, decreased air entry, and decreased vocal fremitus

A

Pneumothorax

77
Q

Patient has difficulty breathing, chest tightness, and coughing that occur fewer than 2 days per week, but does not interfere with normal activities along with nighttime symptoms occur fewer than 2 days per month. What would you rate this patient’s asthma symptoms?

A

Intermittent asthma

78
Q

Patient has difficulty breathing, chest tightness, and coughing that occur more than 2 days a week, but doesn’t occur every day and they interfere with daily activity; with nighttime symptoms occur 3-4 times per month. What would you rate this patient’s asthma symptoms?

A

Mild persistent asthma

79
Q

Patient has difficulty breathing, chest tightness, and coughing that occur daily and interfere with daily activities and asthma medication is used daily; with nighttime symptoms occur more than 1 time per week. What would you rate this patient’s asthma symptoms?

A

Moderate persistent asthma

80
Q

Patient has difficulty breathing, chest tightness, and coughing that every day and severely limit daily activities with nighttime symptoms occur often. What would you rate this patient’s asthma symptoms?

A

Severe persistent asthma

81
Q

Viral infection of bronchiolar epithelium usually occurs in children <2 years

Typically called by RSV, adenovirus, influenza, parainfluenza, and human metapneumovirus (hMRPV)

A

Bronchiolitis

82
Q

Characterized by submucosal edema, increased mucus production, and increased airway resistance/wheezing

A

Bronchiolitis

83
Q

You get a radiograph of your patient with URI symptoms and it shows patchy atelectasis, peribronchial thickening, perihilar prominence, airspace disease, and hyperinflation.

A

Bronchiolitis

84
Q

Mutation of PHOX2B gene that is inherited autosomal dominant that causes inadequate respiratory drive as result of genetic defect in ANS’s control of rbeathing

A

Congenital Central Hypoventilation Syndrome

85
Q

Congenital defect that causes herniation of GI into thoracic cavity; that typically occurs on left side of chest

Commonly occurs with history of polyhydramnios

A

Congenital Diaphragmatic Hernia

86
Q

Common infection that occurs in children 6 months to 3 years; commonly in late fall

Commonly caused by parainfluenza type 1 and 2

A

Laryngotracheobronchitis/Croup

87
Q

Chest x-ray shows narrowing of subglottic area

A

Laryngotracheobronchitis/Croup

“steeple sign”

88
Q

What is the treatment for laryngotrachrobronchitis/croup?

A
  • Cool humidified air
  • Dexamethasone 0.6 mg/kg IV/IM
  • Consider nebulized epinephrine solution
  • Antipyretics
  • Consider heliox administration
89
Q

Autosomal recessive disorder that makes abnormal protein impairing movement of salt and water across epithelial cell wall leading to thick sticky secretions

A

Cystic fibrosis

90
Q

How does cystic fibrosis affect the lungs?

A

Sticky mucus traps bacteria in lungs and causes inflammation and infection

91
Q

How does cystic fibrosis affect the pancreas?

A

Mucus blocks pancreatic ducts which blocks excretion of pancreatic enzymes and bicarbonate leading to malabsorption and malnutrition

92
Q

How does cystic fibrosis affect the intestines?

A

Malabsorption leads to poor growth and large, oily, foul-smelling stools

93
Q

How does cystic fibrosis affect liver?

A

Secretions block bile ducts, but leads to liver damage

94
Q

How does cystic fibrosis affect sinuses?

A

Poor drainage causes sinus disease, infection, and nasal polyps

95
Q

How does cystic fibrosis affect the reproductive tract?

A

Infertility

96
Q

How does cystic fibrosis affect sweat glands?

A

Increased risk of dehydration

97
Q

Group B strep, E. coli, Staph. aureus, herpes simplex virus, Ureaplasma urealyticum are the most common cause of community acquired pneumonia in which age group?

98
Q

RSV is the most common cause of community acquired pneumonia in which age group?

A

Infants up to 1 year

99
Q

Step. pneumoniae, Chlamydia trachomatis, Bordetella pertussis, RSV, influenza and parainfluenza virus are the most common cause of community acquired pneumonia in which age group?

A

1 to 3 months

100
Q

Viral, mycoplasma, c. trachomatis, strep. pneumoniae are the most common cause of community acquired pneumonia in which age group?

A

3 months to 5 years

101
Q

Strep. pneumoniae, Mycoplasma pneumoniae, and C. trachomatis are the most common cause of community acquired pneumonia in which age group?

A

> 5 years of age

102
Q

Caused by B. pertussis and transmitted by aerosol droplets

103
Q

How long is classic duration of cough with pertussis?

A

6-10 weeks

104
Q

What are the best antibiotics to treat pertussis?

A

Macrolides (azithromycin and erythromycin)

105
Q

What is the accumulation of pus in the pleural space due to overgrowth of bacteria?

Acute Care PNP Exam (4 decks)

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