small groups 2

Question 1

Presence of rales indicate what?

Answer 1

Pt likely has fluid of some type in alveolar space (pus, blood, water)

ie: pneumonia (egophony can be heard too)

Question 2

Does the presence of fever and hypotension with absence of heart sound suggest cardiac or non-cardiogenic edema?

Answer 2

noncardiogenic edema

- acute lung injury or ARDS

Question 3

3 general physiologic reasons for hyperventilation

Answer 3

1. compensation for metabolic acidosis
2. hypoxemia
3. CNS causes (trauma, stroke, drugs, voluntary)

Question 4

if pt is severely hypotensive, what can you do?

Answer 4

intubate, give fluids, start on vasopressors

Question 5

major classifications of pulmonary edema

Answer 5

1, cardiogenic

2. noncardiogenis

Question 6

What is considered an normal PCWP?

Answer 6

15 mmhg

• larger = cardiogenic P edema
• normal or smaller = noncardiogenic P edema

Question 7

what is a common way to measure compliance?

Answer 7

pt is on a ventilator and an inspiratory pause is performed

v/p

Question 8

what would compliance be for pts with pneumonia and has developed ARDS? what does that mean?

Answer 8

decreased lung compliance (loss of surfactant –> increase in lung water and surface tension)

this means that it will take a higher pressure to deliver a similar volume on the ventilator

Question 9

scleroderma

Answer 9

join pain -

scleroderma: indicative of collagen vascular disease

Question 10

bilateral symmetric lower extremity edema usualy occurs due to?

Answer 10

1. increase in venous P
   or
2. decrease in oncotic P (starlings law)
   (ie: low serum albumin)

Question 11

Post-capillary HTN is associated with which WHO group for pulm HTN?

Answer 11

WHO group 2: pulmonary venous HTN or Pulm HTN due to LH Disease

Kerly B lines and pulmonary edema on CXR will be seen on post cap HTN

Question 12

Which WHO groups will demonstrate normal lung volumes, and spirometry, and a decreased DLCO

Answer 12

1: Pulm arterial HTN

4. Chronic thromboembolic Pulmonary HTN

Question 13

How can you exclude WHO Group 4 HTN?

Answer 13

Chronic thromboembolic pulmonary HTN (4) can be excluded by looking for emboli using a ventilation-perfusion scan (preferred) or a CT with contrast

Question 14

What neurologic disorder can also lead to respiratory muscle weakness and fatigue?

Answer 14

Guillan barre

Question 15

hypercapnea will do what to respiration? Will giving O2 help dyspnea?

Answer 15

hypercapnea is a potent respiratory stimulus

• problem is too much arterial CO2, giving O2 wont help dyspnea
• ie: hypercapnea via CNS derrangement

if pt is also hypoxic, then you can give them supplemental P2
- ie: hypercapnea + hypoxemia via obesity

Question 16

If pt has a normal A-a gradient, does this tell you anything about DLCO? What if there is a restrictive process going on?

Answer 16

Yes! after correction, DLCO will be normal

DLCO would be reduced in restrictive process due to low lung volumes

Question 17

Key signs pts have neuromuscular disease

Answer 17

1. muscle forces PImax and Pemax will be ↓
2. cannot voluntarily blow their PCO2 down to normal
3. hypoventilation will cause dyspea (since central chemoreceptors are in tact)

Question 18

What does elevated hct do to exacerbate RHF?

Answer 18

Hypoxemia stimulates erythropoetin release from the kidney, which increases hemoglobin levels. The elevated hemoglobin and hematocrit levels increase the viscosity of the blood, which increases resistance to flow (it is easier to pump water than honey through a tube).

This increases the work of the right ventricle.

Question 19

Hypoventilation in fat people are called?

Answer 19

Obesity hypoventilation syndrome (Pickwickian syndrome)

- can be hypercapneic and hypoxemic 24 hours a day, not just sleep apnea at night