RESPIRATORY: 612 - 613

Question 1

What is a pleural effusion?

Answer 1

Excess accumulation of fluid between the 2 pleural layers

Question 2

What are the 2 pleural layers?

Answer 2

Visceral (inner) and parietal (outer)

Question 3

What is the major problem with a pleural effusion?

Answer 3

Restricted lung expansion during inspiration

Question 4

What are the three types of pleural effusion?

Answer 4

1. Transudate
2. Exudate
3. Lymphatic

Question 5

Is protein content higher in transudate or exudate? How can you tell?

Answer 5

Exudate - it’s cloudy

Question 6

What are 3 causes of transudate pleural effusion?

Answer 6

1. CHF
2. Nephrotic syndrome
3. Hepatic cirrhosis

Question 7

What are 4 causes of exudate pleural effusion?

Answer 7

1. Malignancy
2. Pneumonia
3. Collagen vascular disease
4. Trauma

Question 8

What do exudate pleural effusions increase the risk of?

Answer 8

Infection

Question 9

What is a cyclothorax?

Answer 9

Another name for lymphatic pleural effusion

Question 10

What is the underlying cause of lymphatic pleural effusion?

Answer 10

Injury to thoracic duct wither from trauma or malignancy

Question 11

Describe the findings in a cyclothorax.

Answer 11

Milky fluid and increased triglycerides

Question 12

What is a pneumothorax?

Answer 12

Accumulation of air in the pleural space

Question 13

How does a pneumothorax present?

Answer 13

All on affected side:

1. Unilateral chest pain and dyspnea
2. Unilateral chest expansion
3. Decreased tactile fremitus
4. Hyperresonance
5. Diminished breath sounds

Question 14

What are the two types of pneumothorax?

Answer 14

1. Spontaneous

2. Tension

Question 15

Describe the trachea’s position in spontaneous vs. tension pneumothorax.

Answer 15

Spontaneous - deviates to the affected lung (collapsed portion of lung)
Tension - deviates away from the affected lung (trapped air)

Question 16

What is the difference between spontaneous vs. tension pneumothorax?

Answer 16

Both have accumulation of air in the pleural space but in a tension pneumothorax, air cannot EXIT that space

Question 17

Describe the classic scenario for the spontaneous pneumothorax.

Answer 17

Tall, thin, young males who have rupture of an apical bleb

Question 18

What are 2 settings in which tension pneumo’s are common?

Answer 18

1. Trauma

2. Lung infection

Question 19

What is the mechanism of action of H1 blockers?

Answer 19

Reversible inhibitors of H1 histamine receptors

Question 20

How many generations of H1 blockers do we have?

Answer 20

2

Question 21

Name three 1st generation H1 blockers.

Answer 21

1. Diphenhydramine
2. Dimenhydrinate
3. Chlorpheniramine

Names contain “-en/-ine” or “-en/-ate”

Question 22

What are the clinical uses for 1st generation H1 blockers?

Answer 22

Allergy, motion sickness, sleep aid

Question 23

What are the toxicities for H1 blockers?

Answer 23

Sedation, antimuscarinic, anti-alpha-adrenergic

Question 24

Name four 2nd generation H1 blockers.

Answer 24

1. Loratadine
2. Fexofenadine
3. Desloratadine
4. Cetirizine

Names usually end in “-adine”

Question 25

What are 2nd generation H1 blockers used for?

Answer 25

Allergy

Question 26

How do the toxicity of 2nd generation H1 blockers compare to those of 1st generation and why?

Answer 26

Far less sedating than 1st generation because of decreased entry into the CNS

Question 27

What is guaifenesin?

Answer 27

Expectorant - thins respiratory secretions

Question 28

How does guaifenesin affect the cough reflex?

Answer 28

Does NOT suppress cough reflex

Question 29

Describe the mechanism of action of N-acetylcysteine.

Answer 29

Mucolytic

Question 30

What are 2 specific uses for N-acetylcysteine?

Answer 30

1. Loosen mucus plugs in CF patients | 2. Antidote for acetaminophen overdose

Question 31

What is dextromethorphan?

Answer 31

Synthetic codeine analog that is antitussive (antagonizes NMDA glutamate receptors)

Question 32

What effect can dextromethorphan have if used in excess?

Answer 32

Opioid

Question 33

What can be given for dextromethorphan overdose?

Answer 33

Naloxone

Question 34

Describe the mechanism of pseudoephedrine and phenylephrine.

Answer 34

Sympathomimetic alpha-agonistic Reduce hyperemia, edema, and nasal congestion Also open obstructed eustachian tubes

Question 35

What drug can be used illicitly to make methamphetamine?

Answer 35

Pseudoephedrine

Question 36

What are pseudoephedrine and phenylephrine used for?

Answer 36

Nonprescription nasal decongestants

Question 37

What are the toxicities of pseudoephedrine and phenylephrine?

Answer 37

Hypertension Pseudoephedrine can also cause CNS stimulation/anxiety