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RET1293 > Test 3 > Flashcards

Test 3 Flashcards

1
Q

Cystic firbrosis leads the excessive production and accumulation of thick, tenacious mucus in the tracheobronchial tree secondary to ____________________________.

A

Inadequate hydration of the periciliary fluid layer (sol layer)

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2
Q

Partial obstruction leads to what?

A

Over distention of the alveoli

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3
Q

Complete obstruction leads to ____________________.

A

Patchy areas of atelectasis and in some cases bronchiectasis

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4
Q

What are the predominant features of CF in the advanced stages?

A
  • Excessive bronchial secretions
  • Bronchial obstruction
  • Hyperinflation of the lungs
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5
Q

What are the major respiratory pathologic or structural changes associated with CF? (6)

A
  • Excessive production and accumulation of thick, tenacious mucus in the tracheobronchial tree secondary to inadequate hydration of the periciliary layer.
  • Partial bronchial obstruction (mucus plugging)
  • Hyperinflation of the alveoli
  • Total bronchial obstruction (mucus plugging)
  • Atelectasis
  • Bronchiectasis
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6
Q

What is the most common fatal inherited disorder in childhood?

A

Cystic Fibrosis

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7
Q

What type of gene disorder is CF?

A

Autosomal recessive gene disorder caused by mutations in a pair of genes located in Chromosome 7

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8
Q

Under normal conditions, every cell in the body has _______ chromosomes.

A

46 chromosomes - 23 pairs

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9
Q

More than _________ different mutations in the gene that encodes for the cystic fibrosis transmembrane conductance regulator have been described.

A

1700

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10
Q

The most common genetic defect linked to CF involves the absence of three base pairs in ___________ that codes for phenylalanine on chromosome 7 (band q31.2)

A

Codon 508 (ΔF508)

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11
Q

The absence of three base pairs in codon 508 (ΔF508) accounts for ___________ of patients with CF tested.

A

70-75%

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12
Q

The abnormal expression of the CFTR results in what?

A

Abnormal transport of sodium and chloride ions across many types of epithelial surfaces, including those lining the bronchial airways, intestines, pancreas, liver ducts, and sweat glands.

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13
Q

The CFTR mutations that is classified a gating defect means ________________.

A

The channel does not open

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14
Q

The CFTR mutations that is classified as conductance defect means
________________.

A

The channel is open, but chloride does not move effectively.

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15
Q

Because CF is a recessive gene disorder, the child must inherit _______ copies of the defective gene disorder.

A

2 copies, one from each parent to have the disease

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16
Q

If both parents carry the CF gene, the possibility of their children having CF follows the ________________.

A

Standard Mendelian Pattern

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17
Q

When both parents carry a CF gene mutation, there is a _____ in four chance that the chid will have CF.

A

One.

1/4

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18
Q

It is estimated that how many Americans are unknowing, symptomless carriers of the mutant CF gene?

A

10 million

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19
Q

According to the CF Foundation, CF affects about how many children and adults in the US and how many worldwide?

A

US - 30,000
Worldwide - 70,000

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20
Q

About ______ new cases of CF are diagnosed each year in the US.

A

1000

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21
Q

More than ___% of patients are diagnosed with CF by newborn screening.

A

90

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22
Q

More than ____% of the patient population with CF are 18 years or older.

A

50

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23
Q

What is the median age of survival for individuals with CF?

A

In the late 30s, but many patients with CF live into their 40s and beyond.

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24
Q

CF occurs most often in what race?

A

Caucasians (1:3000)

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25
Q

The diagnosis of CF is based on what three things?

A
  1. Clinical manifestations associated with CF
  2. Family history of CF
  3. Lab findings
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26
Q

What two criteria must be met to diagnose CF?

A
  • Clinical symptoms consistent with CF in at least one organ
  • Clinical evidence of CTFR dysfunction
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27
Q

What is classified as clinical evidence of CTFR dysfunction?

A
  • Elevated sweat chloride greater than 60 mEq/L (on two occasions)
  • Molecular diagnosis (genetic testing). Presence of two disease-causing mutations in CFTR.
  • Abnormal nasal potential difference
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28
Q

Newborn screening for CF has been part of the newborn genetic testing protocol in all 50 states since _____.

A

2011

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29
Q

Most infants with CF have an elevated blood level of immunoreactive trypsin, which can measured by ________________.

A
  • Radioimmunoassay
  • An enzyme-linked immunoassay
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30
Q

Immunoreactive trypsin is also called what?

A

Trypsin-like immunoreactivity or serum trypsin

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31
Q

The immunoreactive trypsin level (IRT) is measured from the ___________ collected on all newborn infants on the Guthrie cards.

A

blood dots

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32
Q

The CF screening protocol varies among states and will identify more than ____% of infants wit CF.

A

90

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33
Q

What is the most common CF protocol?

A

Perform DNA screening for 32 to 85 of the most common CF mutations on 2-5% of the samples with the highest IRT levels

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34
Q

The diagnosis of CF is established by what?

A

A positive sweat test and/or genetic analysis for CF mutations

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35
Q

What identifies a newborn as a CF carrier?

A

Negative or normal sweat test

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36
Q

_________________ is the gold standard diagnostic test for CF.

A

Sweat test or sweat chloride test

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37
Q

The sweat test is a reliable test for the identification of about ____% of patients with CF.

A

98

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38
Q

CF Pancreas Mnemonic

A

Chronic Respiratory Disease
Failure to Thrive
Polyps
Alkalosis, Metabolic
Neonatal intestinal obstruction
Clubbing of fingers
Rectal prolapse
Electrolyte increase in sweat
Aspermia/absent vas deferens
Sputum: Staphylococcus aureus, Pseudomonas aeruginosis

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39
Q

What does the sweat test measure?

A

Amount of sodium and chloride in the patient’s sweat

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40
Q

During the sweat test procedure, a small amount of a colorless, odorless sweat-producing chemical is applied to the patient’s arm or leg. What is this chemical called?

A

Pilocarpine

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41
Q

How many times is the sweat test usually done?

A

Twice

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42
Q

How is sweat produced during a sweat test?

A

An electrode is attached to the chemically prepared area, and a mild electric current is applied to stimulate sweat production.

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43
Q

Although the sweat glands of patients with CF are microscopically normal, the glands secrete up to ________ the normal amount of sodium and chloride.

A

FOUR TIMES

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44
Q

In both infants and adults, a sweat chloride concentration greater than _______ is considered to be a diagnostic sign of CF.

A

60 mEq/L

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45
Q

With a sample of the patient’s _______________, a genetic test can be performed to analyze DNA for the presence of CFTR gene mutations.

A

Blood or cheek cells

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46
Q

Most of the diagnostic laboratories in the US are able to screen for at least ________ of the most common mutations.

A

30-100

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47
Q

What is the sweat test interpretations?

A

Infants 6 mo. or YOUNGER
Normal: Less than or equal to 29 mmol/L
Intermediate: 30-59 mmol/L
Abnormal: Greater or equal to 60 mmol/L

Infants Older than 6 mo, Children & Adults
Normal: Less than or equal to 39 mmol/L
Intermediate: 40-59 mmol/L
Abnormal: Greater or equal to 60 mmol/L

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48
Q

It is estimated that genetic testing can confirm CF in about how many of the patients tested?

A

90-96%

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49
Q

As the sodium and chloride ions move across the epithelial cell membrane, they generate what is called an __________________.

A

Electrical Potential Difference

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50
Q

Define Electrical Potential Difference.

A

The amount of energy required to move an electrical charge from one point to another.

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51
Q

Where can the nasal potential difference be measured?

A

With a surface electrode over the nasal epithelial cells lining the inferior turbinate

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52
Q

What does an increased nasal potential difference suggest?

A

CF

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53
Q

The nasal potential difference is recommended for what type of patients?

A

Patient with clinical features of CF who have borderline or normal sweat test values and nondiagnostic CF genotyping.

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54
Q

If desired, a fetus can be tested for CF by amniocentesis during what trimester?

A

First

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55
Q

Fetal cells are tested for the presence of CF mutations and identified as what?

A
  • CF affected
  • CF carrier
  • Normal
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56
Q

___________________ is very important in all cases of prenatal testing for CF to explain the uncertainty or residual risk to prospective parents.

A

Genetic counseling

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57
Q

Explain fecal fat test.

A

It measures the amount of fat in the infant’s stool and the percentage of dietary fat that is not absorbed by the body.

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58
Q

Infants with CF and pancreatic insufficiency will have a fecal elastance of ____________.

A

Less than 50 µg/g

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59
Q

What is the normal fecal elastance value?

A

Greater than 300 µg/g

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60
Q

What is the stool fecal fat test used to evaluate?

A

How the liver, gallbladder, pancreas and intestines are functioning.

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61
Q

What are the major anatomic alterations of the lungs associated with CF? (3)

A
  • Bronchospasm
  • Excessive bronchial secretions
  • Atelectasis
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62
Q

Define spontaneous pneumothorax.

A

No obvious injury could have caused the pneumothorax.

Side note: Once you’ve have one, there’s about a 50% chance that it will recur.

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63
Q

Describe the physical examination of a CF patient.

A
  • Increased RR (Tachypnea)
  • Increased HR and BP
  • Use of accessory muscles of inspiration/expiration
  • Pursed-lip breathing
  • Cyanosis
  • Digital clubbing
  • Peripheral edema and venous distention
  • Diminished heart and breath sounds
  • Decreased or increased tactile fremitus
  • Hyperresonant percussion note
  • Bronchial breath sounds
  • Crackles
  • Wheezing
    -Spontaneous pnuemothorax
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64
Q

What would an ABG look like for a patient MILD TO MODERATE CF?

A

Acute Alveolar Hyperventilation with Hypoxemia (Acute Respiratory Alkalosis)

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65
Q

What would an ABG look like for a patient SEVERE STAGE CF?

A

Chronic Ventilatory Failure with Hypoxemia (Compensated Respiratory Acidosis)

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66
Q

What are the abnormal lab test associated with CF?

A

Increased hematocrit and hemoglobin
Increased WBC
Hypoxemia makes the blood produce more blood cells

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67
Q

What are some radiologic findings of CF? (8)

A
  • Translucent (dark) lung fields
  • Depressed or flattened diaphragm
  • Right ventricular enlargement (Cor pulmonale)
  • Areas of atelectasis or fibrosis
  • Tram tracks
  • Bronchiectasis (often a secondary complication)
  • Pnuemothorax (spontaneous)
  • Abscess formation
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68
Q

About _____% of men with CF are infertile.

A

99

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69
Q

Nasal polyps are seen in between _________ of patients with CF.

A

10% and 30%

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70
Q

What is meconium ileus?

A

Obstruction of the small intestine of the newborn that is caused by the impaction of thick, dry, tenacious meconium, usually at or near the ileocecal valve.

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70
Q

What are the primary goals for patients with CF?

A
  1. Prevent pulmonary infections
  2. Reduce the amount of thick bronchial secretions
  3. Improve airflow
  4. Provide adequate nutrition
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71
Q

Hypoxemia may NOT respond well to oxygen therapy when ____________ is present.

A

True or capillary pulmonary shunting

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72
Q

What are keys to reversing consolidation caused by mucous plugging?

A

Deep breathing and effective cough

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73
Q

When do you want to administer bronchodilators to CF patients?

A
  • Before patient receives chest physiotherapy or exercise
  • Before patient receives inhaled nebulized hypertonic saline, antibiotics and/or dNASE to offset bronchial constriction
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74
Q

What are recommended bronchodilators for CF?

A

SABA - Albuterol
LABA - Salmeterol and Formoterol

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75
Q

What is Ivacaftor’s brand name?

A

Kalydeco

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76
Q

What may be used to hydrate thick mucus in the airways of patients with CF who are 6 years of age or older, have a chronic cough or have a reduced FEV1?

A

Inhaled hypertonic saline

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77
Q

Inhaled hypertonic saline is usually given with a bronchodilator how often?

A

Twice a day.

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78
Q

What medication has not been proven to be effective in treating patients with CF?

A

Inhaled N-acetylcysteine

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79
Q

Drugs that help mutated CFTR reach the epithelial cell surface where the CFTR protein normally functions as a transmembrane regulator of chloride movement out of the cell and sodium transport into the cell.

A

Correctors

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80
Q

Drugs that help mutated CTFR function more effectively at the epithelial cell surface transporting chloride out of the cell and inhibiting the movement of sodium into the cell.

A

Potentiators

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81
Q

An oral potentiator molecule that has been proved effective to improve cell function and clinical status in patients with CF with the G551D mutation.

A

Ivacaftor (Kalydeco)

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82
Q

Which of the following organisms are commonly found in the tracheobronchial tree secretions of patients with. CF?

A
  • Staphylococcus
  • Haemophilus influenzae
  • Pseudomonas aeruginosa
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83
Q

About 80% of all patients with CF demonstrate a deficiency in which of the following vitamins?

A

D, A, K, E

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84
Q

Bronchiectasis is an acquired disorder of the major bronchi and bronchioles characterized by what?

A

Chronic dilation and distortion of one or more bronchi

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85
Q

Bronchiectasis is commonly limited to a lobe or segment and is commonly found in which part of the lungs?

A

Lower lobes

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86
Q

Reid classification subdivides bronchiectasis into what following three patterns?

A
  • Varicose (fusiform)
  • Cylindrical (tubular)
  • Cystic (saccular)
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87
Q

The bronchi are dilated and constricted in an irregular fashion, ultimately resulting in a distorted bulbous shape.

A

Varicose (fusiform) bronchiectasis

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88
Q

The bronchi progressively increase in diameter until they end in large, cystlike sacs in the lung parenchyma.

A

Cystic (saccular) bronchiectasis

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89
Q

The bronchi are dilated and rigid and have regular outlines similar to a tube.

A

Cylindrical (tubular) bronchiectasis

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90
Q

With cylindrical (tubular) bronchiectasis, X-ray shows that the dilated bronchi fail to taper for _______ generations and then appear to end abruptly because of mucous obstruction.

A

6-10

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91
Q

Which form of bronchiectasis causes the greatest damage to the tracheobronchial tree?

A

Cystic (saccular) bronchiectasis

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92
Q

With cylindrical (tubular) bronchiectasis, the bronchial walls becomes composed of _______ alone.

A

Fibrous tissue,

Cartilage, elastic tissue and smooth muscle are all absent

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93
Q

What are the major pathologic or structural changes associated with bronchiectasis? (7)

A
  • Chronic dilation and distortion of bronchial airways
  • Excessive production of often foul-smelling sputum
  • Bronchospasm
  • Alveoli hyperinflation
  • Atelectasis
  • Parenchymal consolidation and fibrosis
  • Hemoptysis secondary to bronchial arterial erosion
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94
Q

Most causes of bronchiectasis include some combination of ____________ and ______________.

A

Bronchial obstruction and infection

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95
Q

In developed countries, ______________ is the most common causes of bronchiectasis in children.

A

CF

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96
Q

In the US, the incidence of NCFB is about _______________.

A

4.2 per 100,000 young adults

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97
Q

The low incidence of NCFB in developed countries is most often attributed to what?

A

Early medical management.

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98
Q

What is the most common causes of NCFB?

A

Pulmonary infection

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99
Q

The causes of bronchiectasis are commonly classified in what following categories?

A
  • Acquired bronchial obstruction
  • Congenital anatomic defects
  • Immunodeficiency states
  • Abnormal secretion clearance
  • Miscellaneous disorders
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100
Q

A routine chest radiograph of bronchiectasis may reveal what? (11)

A
  • Overinflated lungs
  • Marked volume loss
  • Increased opacities
  • Dilated fluid-filled airways
  • Crowding of the bronchi
  • Translucent (dark) lung fields
  • Depressed and flattened diaphragms
  • Long and narrow heart pulled down by diaphragm
  • Enlarged hearted when heart failure present
  • Tram tracks
  • Areas of consolidation and/or atelectasis may or may not be seen
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101
Q

What has replaced bronchograms as the gold standard for the diagnosis of NCFB?

A

HR-CT (High-Resolution Computed Tomogram)

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102
Q

The diagnosis of bronchiectasis is made on the basis of what three things?

A
  • Internal diameter of the bronchus that is wider than its adjacent pulmonary artery
  • Failure of the bronchi to taper
  • Visualization of bronchi in the outer 1-2 cm of lung fields
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103
Q

The HR-CT is used to better clarify the findings of the chest radiograph and standard CT scans, and allows ____________ of airway abnormalities that cannot be identified on routine films of the chest.

A

Lung Mapping

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104
Q

What can be used to determine if the bronchiectasis demonstrates primarily an obstructive or restrictive lung pathophysiology?

A

Spirometry

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105
Q

What can be used to determine if the patient has mild, moderate or severe gas exchange compromise?

A

ABG

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106
Q

You will see pursed-lip breathing in bronchiectasis patients when their pathology is primarily ___________________.

A

Obstructive

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107
Q

State the clinical manifestations of bronchiectasis. (4)

A
  • Excessive bronchial secretions
  • Bronchospasm
  • Consolidation
  • Increased alveolar-capillary membrane thickness
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108
Q

What is the hallmark of bronchiectasis?

A

Chronic cough with large production of foul-smelling sputum

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109
Q

Which anaerobic organisms are commonly cultured from the sputum of bronchiectasis patients?

A
  • Haemophilus influenzae
  • Streptococcus
  • Psuedomonas aeruginosa
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110
Q

The productive cough seen in patients with bronchiectasis is triggered by __________________.

A

The large amount of secretions that fill the trachebronchial tree

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111
Q

The subepithelial mechanoreceptors are found in the trachea, bronchi and bronchiole but are predominantly located ____________.

A

In the upper airways

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112
Q

What are chest assessment findings in bronchiectasis that is primarily obstructive?

A
  • Decreased tactile and vocal fremitus
  • Hyperresonant percussion note
  • Diminished breath sounds
  • Wheezing
  • Crackles
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113
Q

What are chest assessment findings in bronchiectasis that is primarily restrictive? (5)

A
  • Increased tactile and vocal fremitus
  • Bronchial breath sounds
  • Crackles
  • Whispered pectoriloquy
  • Dull percussion note
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114
Q

How does a PFT look for a moderate or severe bronchiectasis patient?

A

Everything normal or DECREASED.
RV/TLC ratio normal

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115
Q

Bronchiectasis: Hematology

A
  • Increased hematocrit and hemoglobin
  • Elevated WBC if patient is acutely infected
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116
Q

Parallel or curved opacity lines of varying length caused by bronchial wall thickening.

A

Tram tracks

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117
Q

Which type of bronchiectasis would tram-track opacitites most likely be seen in?

A

Cylindrical bronchiectasis

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118
Q

What is the general treatment plan for bronchiectasis?

A

Control pulmonary infections, airway secretions and airway obstruction and preventing complications

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119
Q

USE OF CORTICOSTEROIDS IS DISCOURAGED WITH BRONCHIECTASIS.

A

JUST KNOW

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120
Q

What are some airway clearance techniques used for bronchiectasis?

A
  • Directed cough
  • CPT (Postural drainage)
  • Suctioning
  • PEP
  • High-frequency chest wall oscillation
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121
Q

What are the major pathologic or structural changes associated with pnuemonia? (3)

A
  • Inflammation of the alveoli
  • Alveolar consolidation
  • Atelectasis
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122
Q

Atelectasis is often associated with patients who have ___________________.

A

Aspiration pneumonia

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123
Q

What are some causes of pneumonia? (9)

A
  • Bacteria
  • Viruses
  • Fungi
  • Protozoa
  • Parasites
  • TB
  • Anaerobic organisms
  • Aspiration
  • Inhalation of irritating chemicals such as chlorine
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124
Q

Polymorphonuclear leukocytes move into the infected area and engulf and kill invading bacteria on the alveolar walls. What is this called?

A

Surface phagocytosis

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125
Q

Taken together, pneumonia and influenza combined are the _________ leading cause of death among Americans.

A

eigth

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126
Q

Taken together, pneumonia and influenza combined are the _________ leading cause of death among Americans over the age of 65.

A

sixth

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127
Q

It is estimated that ____________ Americans die of pneumonia each year.

A

50,000

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128
Q

What is the leading cause of morbidity and mortality in children beyond the neonatal period?

A

Pneumonia

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129
Q

Pneumonia often mimics a __________________.

A

Cold or flu

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130
Q

What is characterized by a patchy pattern of infection that is limited to the segmental bronchi and surrounding lung parenchyma?

A

Bronchopneumonia

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131
Q

Bronchopneumonia usually involves both lungs and is often seen in which part of the lung?

A

Lower lobes

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132
Q

_____________ is a widespread of diffuse alveolar inflammation and consolidation confined to one or more lobes of the lungs.

A

Lobar pneumonia

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133
Q

Interstitial pneumonia is usually a diffuse and often bilateral inflammation that primarily involves ___________________.

A

The alveolar septa and interstitial spaces

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134
Q

Which type of pneumonia is typically the end result of a severe or long term bronchopneumonia?

A

Lobar pneumonia

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135
Q

When both lungs are involved, the condition is sometimes called _______________.

A

“double pneumonia” by laypersons.

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136
Q

What term is often used to describe a mild case of pneumonia?

A

Walking pneumonia

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137
Q

What are some risk factors for pneumonia?

A
  • Age over 65 years
  • AIDS
  • Rib fractures
  • Cancer
  • Viral respiratory infections
  • Prolonged bed rest
  • Chronic respiratory disease
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138
Q

__________________ refers to a pneumonia acquired from normal social contact.

A

CAP - Community-acquired pneumonia

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139
Q

What type of pneumonia accounts for more than 80% of all bacterial pneumonias?

A

Streptococcus pneumoniae pneumonia

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140
Q

Is streptococcus gram-positive or negative?

A

Positive

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141
Q

What type of S. pneumoniae organism is the most virulent?

A

Serotype 3

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142
Q

There are more than ___ types of S. pneumoniae.

A

80

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143
Q

How is streptcocci generally transmitted?

A

By aerosol from a cough or sneeze of an infected person.

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144
Q

S. pneumoniae and H. influenzae is commonly cultured from the sputum of patients having an acute exacerbation of ___________.

A

Chronic bronchitis

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145
Q

What are two major groups of staphylococcus?

A
  1. staphylococcus aureus, most responsible for “staph” infections in humans
  2. staphylococcus albus and staphylococcus epidermidis, part of the normal skin flora
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146
Q

______________ are a common cause of hospital-acquired pneumonia or nosocomial pnueumonia.

A

Staphylococci, becoming increasingly antibiotic resistant

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147
Q

_____________ is a common inhabitant of human pharyngeal flora.

A

Haemophilus influenzae

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148
Q

Most strains of S. pneumoniae are sensitive to __________________.

A

Penicillin and its derivatives

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149
Q

A gram-positive, nonmotile coccus that is found singly, in pairs and in irregular clusters

A

Staphylococcus

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150
Q

Rod-shaped organisms that are the major gram-negative organisms responsible for pneumonia.

A

Bacilli

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151
Q

A gram-positive, nonmotile bacterium that occurs singly, in pairs, and in short chains.

A

Streptococcus

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152
Q

How is staphylococcus aureus transmitted?

A

By air from a cough/sneeze of an infected person and indirectly via contact with contaminated floors, bedding, floors and clothes.

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153
Q

There are 6 types of H. influenzae, designated A to F, but only type ____ is commonly pathogenic.

A

B

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154
Q

How does H. influenzae appear on gram stain?

A

Coccobacilli

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155
Q

Is H. influenzae gram-negative or positive?

A

Negative

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156
Q

Pneumonia caused by H. influenzae is most often seen where?

A

Children 1 month to 6 years old.

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157
Q

H. influenzae type B is almost always the cause of _________________.

A

Acute epiglottitis

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158
Q

How is H. influenzae transmitted? What environment does this organism survive best in?

A

Via aerosol or contact with contaminated objects. It is sensitive to the cold and does not survive long after expectoration.

159
Q

Pneumonia associated with Legionella pneumophila is termed…..

A

Legionnaire’s disease

160
Q

Organism that multiplies in standing water such as contaminated mud puddles, large air-conditioning systems and water tanks.

A

Legionella pneumophila

161
Q

Where can Legionella pneumophila be detected?

A
  • Pleural fluid
  • Sputum
  • Lung tissue
162
Q

Where is Legionnaire’s disease commonly seen?

A

Middle-aged men who smoke

163
Q

_______________________ have been long associated with lobar pneumonia, particularly in men over 40 an chronic alcoholics of both genders.

A

Klebsiella pneumoniae

164
Q

Is Klebsiella pneumoniae gram-positive or negative?

A

Negative

165
Q

Klebsiella pneumoniae is a normal inhabitant of the __________________.

A

Human gatrointestinal tract

166
Q

Why is the morality of patients with Klebsiella pneumoniae so high?

A

Because frequent septicemia is a frequent complication

167
Q

Klebsiella pneumoniae is a common nosocomial disease.

A

Fact.

168
Q

A gram-negative diplococcus that commonly colonizes the upper respiratory tract, particularly in children.

A

Moraxella catarrhalis

169
Q

What is often found as a cause of acute otitis media in kids and is also associated with exacerbations in adults with COPD?

A

Moraxella catarrhalis

170
Q

A highly mobile, gram-negative bacillus. Often found in the GI tract, burns and catheterized urinary tract.

A

Pseudomonas aeruginosa

171
Q

________________ is frequently cultured from the respiratory tract of patients who are chronically ill and tracheostomized and is the leading cause of healthcare-associated pneumonia.

A

Pseudomonas aeruginosa

172
Q

Where does Pseudomonas aeruginosa thrive?

A

In dampness, so it is often cultured from contaminated RT equipment.

173
Q

Describe the sputum of patient with a Pseudomonas infection.

A

Frequently green and sweet smelling

174
Q

The mycoplasma organism is the most common cause of ______________.

A

An acquired atypical pneumonia.

175
Q

The pneumonia caused by the mycoplasmal organism is commonly described as a _____________.

A

Primary atypical pneumonia

176
Q

What are common symptoms of mycoplasma pneumonia?

A

A cough that tends to come in violent attacks, producing only a small amount of white mucus. Some experience nausea or vomiting and a profound weakness that lasts a long time.

177
Q

Where is mycoplasma pneumonia commonly seen?

A

Children and young adults.
Spreads easily at shelters, schools, child-care centers.

178
Q

A gram-negative bacterium that causes Q fever in humans

A

Coxiella burnetti

179
Q

How is Coxiella burnetti spread?

A

Aerosol from infected people and in living animals such as cattle, sheep and goats.

180
Q

Which adenovirus serotypes cause viral infections and pneumonia in all age groups?

A

4, 7, 14 and 21

181
Q

Mycoplasma organisms are smaller than bacteria, but bigger than ___________.

A

Viruses

182
Q

The term atypical refers to what?

A
  1. Cannot be identified by bacteriologist test
  2. Moderate amount of expectorated sputum
  3. Only moderately elevated WBC
  4. Lack of alveolar exudate
183
Q

______________ and _________________ closely resemble the clinical manifestations of those caused by M. pneumoniae.

A

Chlamydia spp. pneumonia and C.burnetti

184
Q

Chlamydia is a type of bacterium found where?

A

In the cervix, urethra, rectum, throat and respiratory tract. Also found in the feces of various birds.

185
Q

Viruses account for about ___% of all pneumonias, and several are associated with a community-acquired atypical pneumonia.

A

50

186
Q

What type of pneumonia tends to start with flu-like symptoms?

A

Viral pneumonias

187
Q

Viral pneumonia always carries the risk for development of a secondary bacterial pneumonia

A

Fact

188
Q

Minute organisms that aren’t visible by ordinary light microscopy.

A

Viruses

189
Q

About ____% of acute upper respiratory tract infections are caused by viruses.

A

90

190
Q

___________ are the most common cause of pneumonia in young children.

A

Respiratory viruses

191
Q

What disorders belong to the paramyxovirus group?

A

Parainfluenza, mumps and rubella viruses

192
Q

Where is RSV most often seen?

A

Children younger than 12 months and in older adults with underlying heart or pulmonary disease.

193
Q

Almost all children will be infected with RSV by ___________.

A

their second birthday.

194
Q

RSV infections are most commonly seen in patients during when?

A

During the late fall, winter or early morning spring months.

195
Q

What major types of parainfluenza virus are the major causes of infection in humans?

A

1, 2, 3

196
Q

Which major type of parainfluenza virus is considered a croup type of virus?

A

Type 1

197
Q

Which major types of parainfluenza virus are associated with severe infections?

A

2 & 3

198
Q

How is parainfluenza transmitted?

A

By aerosol droplets and by direct person-to-person contact.

199
Q

The influenza viruses type _______ are the most common cause of viral respiratory tract infections.

A

A & B

200
Q

In the US, influenza A & B commonly occur in epidemics during ____________.

A

Winter months

201
Q

How is influenza spread?

A

Person to person by aerosol droplets

202
Q

What is often the first sign of an epidemic?

A

Increase in school absenteeism

203
Q

In what area does influenza survive well in?

A

Low temperatures and humidity

204
Q

What is influenza’s incubation period?

A

1-3 days

205
Q

Adenovirus type _____ has been related to fatal cases of pneumonia in children.

A

7

206
Q

How is adenoviruses transmitted?

A

Aerosol

207
Q

Pneumonia caused by adenovirus generally during what seasons?

A

Fall, winter and spring

208
Q

A negative single-stranded RNA virus associated with a family of viruses that also include RSV and parainfluenza.

A

human metapneumovirus (hMPV)

209
Q

What is the second most common cause of lower respiratory tract infections in young kids?

A

human metapneumovirus (hMPV)

210
Q

Pneumonia that occurs 48 hours or more after hospital admission and that was not present at the time of admission.

A

Hospital-acquired pneumonia, nosocomial pneumonia

211
Q

In the patients who develops pneumonia 4 to 7 days days of hospitalization, the most common pathogens are ___________.

A

MRSA
S. pneumoniae and H. influenzae

212
Q

______________ refers to patient who have been hospitalized in an acute-care hospital within 90 days of the infection, who have resided in a nursing home or long-term facility or who have received parenteral antimicrobial therapy, chemotherapy or wound care within 30 days of pneumonia.

A

Health care-associated pneumonia (HCAP)

213
Q

______________ is defined as a pneumonia of infectious disease origin that develops more than 48 to 72 hours after endotracheal intubation.

A

Ventilator-associated pneumonia

214
Q

What are common VAI agents? (6)

A
  • P. aeruginosa
  • Enterobacter
  • Klebsiella
  • Acinetobacter spp.
  • Stenotrophomonas maltophilia
  • S. aureus
215
Q

Aspiration of gastric fluid with a pH of ______________ causes a serious and often fatal form of pneumonia.

A

2.5 or less

216
Q

What are the major cause of anaerobic infections?

A

Aspiration of oropharyngeal secretions and gastric fluids.

217
Q

Why is aspiration pneumonitis commonly missed?

A

Because the acute inflammatory reaction may not begin until several hours after observed aspiration of the gastric fluid.

218
Q

Mendelson first described aspiration pneumonia as the clinical manifestations of what?

A

Tachycardia, dyspnea, and cyanosis

219
Q

Mendelson syndrome is usually confined to aspiration pneumonitis in ________.

A

Pregnant women

220
Q

There are at least 3 distinctive forms of aspiration pneumonia, classified according to the nature of the aspirate, clinical presentation and management guidelines, as follows:

A
  1. Toxic injury to the lung
  2. Obstruction
  3. Infection
221
Q

What is presumed to be the cause of nearly all cases of anaerobic infection?

A

Aspiration

222
Q

What is a good measurement if aspiration is suspected?

A

Oximetry

223
Q

Aspiration of gastric contents causes ___________ regardless of the pH level of the aspirate.

A

Initial hypoxemia

224
Q

If the PH of the aspirate is _________, the initial injury is rapidly reversible.

A

Relatively high (greater than 5.9)

225
Q

What occurs when food is aspirated?

A

Obliterative bronchiolitis with subsequent granuloma formation occurs

226
Q

What happens if the pH of an aspirate is low?

A

Parenchyma damage may occur, with inflammation, edema and hemorrhage.

227
Q

What is the normal range of unbuffered gastric contents?

A

1 to 1.5

228
Q

The regurgitation of stomach contents into the esophagus is known as ____________.

A

GERD - gastroesophageal reflux disease

229
Q

GERD is how many more times more prevalent in patients with asthma than in other patients?

A

Three times more

230
Q

GERD causes chronic cough in ______ of patients.

A

10-20%

231
Q

What are the normal swallowing mechanic phases?

A
  • Oral preparatory
  • Oral
  • Pharyngeal
  • Esophageal
232
Q

Which two swallowing mechanic phases are considered voluntary stages?

A

The first two stages.

233
Q

Respiration is halted during which phase for about 1 second?

A

Pharyngeal phase

234
Q

Bolus transit in the esophageal phase lasts how many seconds?

A

8-20 seconds

235
Q

Expiration before and after which phase in normal swallowing is believed to serve as an inherent closure and clearance mechanism against penetration of food or liquids in the airway entrance?

A

Pharyngeal phase

236
Q

What is the result of an abnormal swallow that can involve the oral, pharyngeal and esophageal phases?

A

Dysphagia

237
Q

Define aspiration.

A

The passage of food or liquid into the trachea via the vocal cords.

238
Q

What is this test called?
Instilling a deep blue dye into the GI tract and seeing if it can be suctioned from the trachea.

A

Evans blue dye test

239
Q

What are some diagnostic test for dysphagia? (4)

A
  • Modified barium swallow
  • Video fluoroscopy
  • Video-fiberoptic endoscopy
  • Modified Evans blue dye test.
240
Q

If the blue dye from the Evans blue dye test can be suctioned from the trachea, what does that suggest?

A

Tracheoesophageal fistula

241
Q

What are the most definitive tests used for identification of the particular phase of the swallow that is dysfunctional?

A
  • Modified barium swallow
  • Cine-videofluoroscopy
242
Q

Aspiration that does not evoke clinically observable adverse symptoms such as overt coughing, choking and immediate respiratory distress.

A

Silent aspiration

243
Q

Some patients have silent aspiration after ________.

A

A stroke

244
Q

It is estimated that about how many trach or intubated patients aspirate?

A

55-70%

245
Q

Patient with chronic pneumonia usually have ______.

A

Granulomatous inflammation

246
Q

Granulomas associated with chronic pneumonia are commonly seen in patients with what?

A

TB and fungal disease

247
Q

_________ is typically a localized lesion in patients with a normal immune system, with or without regional lymph node involvement.

A

Chronic pneumonia

248
Q

Because most fungi are aerobes, the ______ is a prime site for fungal infections.

A

lung

249
Q

What are the major pathological or structural change of the lungs associated with fungal diseases? (5)

A
  • Alveolar consolidation
  • Alveolar-capillary destruction
  • Caseous tubercles or granulomas
  • Cavity formation
  • Fibrosis and secondary calcification of the lung parenchyma
250
Q

As many as ______ fungal species may be linked to disease in animals.

A

300

251
Q

In plants, what is the most common cause of death and destruction?

A

Fungal disease

252
Q

Human fungal disease is also called what?

A

Mycotic disease or mycosis

253
Q

What is the most common fungal infection in the US?

A

Histoplasmosis

254
Q

What is Histoplasmosis caused by?

A

Histoplasmosis capsulatum

255
Q

Where is the prevalence of histoplasmosis especially high?

A

The major river valleys of the Midwest and South
(Ohio, Michigan, Illinois, Mississippi, Missouri, Kentucky, Tennessee, Georgia and Arkansas)

256
Q

Histoplasmosis is often called __________.

A

Ohio Valley Fever

257
Q

Where is H. capsulatum commonly found?

A

In soils enriched with bird excreta, such as soil near chicken houses, pigeon lofts, barns and trees where starlings and blackbirds roost. Also may be carried by bats.

258
Q

What is the incubation period for H. capsulatum?

A

About 17 days

259
Q

What is the most common form of histoplasmosis?

A

Asymptomatic histoplasmosis

260
Q

This type of histoplasmosis tends to occur in otherwise healthy individuals who have had an intense exposure to H. capsulatum.

A

Acute symptomatic pulmonary histoplasmosis

261
Q

What is characterized by infiltration and cavity formation in the upper lobes of one or both lungs?

A

Chronic pulmonary histoplasmosis

262
Q

People who have inhaled a large number of spores may develop severe acute pulmonary syndrome, which causes the patient to be extremely SOB. What is this called?

A

Spelunker lung, it usually develops after excessive exposure to bat shit when individuals explore caves.

263
Q

Where is disseminated histoplasmosis most often seen?

A

In very young or very old patients with compromised immune systems.

264
Q

What is considered the gold standard for detecting histoplasmosis?

A

Fungal culture test

265
Q

What is the disadvantage of fungal culture tests?

A

It takes time for the fungus to grow - 4 weeks. Treatment delays may be fatal for the patient.

266
Q

What type of test checks for blood serum for antigen and antibodies?

A

Blood Serology Test

267
Q

__________ is cause by inhalation of the spores of coccidiodes im motifs, which are spherical fungi carried by wind-borne dust particles.

A

Coccidioidomycosis

268
Q

Where is Coccidioidomycosis especially prevalent?

A

California, Arizona, Nevada, New Mexico, Texas and Utah.

269
Q

About 80% of the people in __________ have positive coccidiodin skin-test results.

A

San Joaquin Valley

270
Q

Which disease is known as “California Fever”, “desert rheumatism” and “Valley Fever”?

A

Coccidioidomycosis

271
Q

Chronic progressive pulmonary disease is characterized by modular growths called _______ and cavity formation in the lungs.

A

Fungomas

272
Q

Disseminated coccidioidomycosis occurs in about _____ in 6000 exposed persons.

A

1

273
Q

With disseminated coccidioidomycosis, skin lesions are commonly accompanied by arthralgia or arthritis, especially in the ankle and knees. What is this condition commonly called?

A

“Desert bumps”, “desert arthritis” or “desert rheumatism”

274
Q

_____________ is also called “Chicago disease”, “Gilchrist disease” and North American blastomycosis?

A

Blastomycosis

275
Q

Where does blastomycosis occur?

A

South-central and midwestern US and in Canada.

276
Q

What is blastomycosis caused by?

A

Blastomyces dermatitidis

277
Q

Blastomycosis is most common among __________.

A

Pregnant women and middle-aged African American men. This disease is also found in dogs, cats and horses.

278
Q

What is the primary part of entry for B. dermatitidis?

A

Lungs

279
Q

_____________ is known as Friedländer bacillus.

A

Klebsiella pneumoniae

280
Q

In the absence of a secondary bacterial infection, the inflammation caused by the aspiration of gastric fluids usually becomes insignificant in _________ hours.

A

Approximately 72 hours (3 days)

281
Q

Where is cryptococcus most often seen?

A

In patients with HIV and undergoing steroid therapy. It proliferates in high nitrogen content of pigeon droppings and is readily scattered into the air air dust.

282
Q

Where is aspergillus found?

A

Soil, vegetation, leaf detritus, food and compost heaps.

283
Q

Aspergillus infection occurs in the lungs, where it may be present in the form of _________.

A

ABPA - allergic bronchopulmonary aspergillosis

284
Q

What is the most common viral pulmonary complication of AIDS?

A

CMV - cytomegalovirus

285
Q

CMV commonly coexists with what?

A

Pneumocystis jiroveci infection

286
Q

Mycobacterium avium complex is a serious opportunistic infection that is caused by what two similar bacteria?

A

Mycobacterium avium & Mycobacterium intercellulare

287
Q

Where is MAC found?

A

soil and dust particles

288
Q

MAC is commonly found in patients that have _______.

A

AIDS

289
Q

________________ is general term used for a wide variety of infections caused by the fungi of the genus Aspergillus.

A

Invasive aspergillosis

290
Q

The varicella virus usually causes a benign disease in children aged _________.

A

2-8 years

291
Q

What is the mortality rate of varicella pneumonia?

A

About 20%

292
Q

All species of the genus Rickettsia are unstable outside of the cells except for ________.

A

R. Burnetti (Q fever)

293
Q

Small, pleomorphic coccobacilli. They are intracellular parasites possessing both RNA and DNA.

A

Rickettsiae

294
Q

How is measles spread?

A

From person to person by the respiratory route

295
Q

In _______, China reported the first cause of SARS.

A

2002

296
Q

Health officials believe that the cause of SARS is a newly recognized virus strain called ________.

A

Coronavirus

297
Q

What is the incubation period for SARS?

A

2-7 days

298
Q

What percent of patients who develop SARS require mechanical ventilation?

A

10-20%

299
Q

The aspiration of mineral oil, used medically as a lubricant has been known to cause pneumonitis…

A

Lipoid pneumonitis

300
Q

Avian influenza A is also called ________.

A

Bird flu or H5N1

301
Q

What year was the first avian influenza virus that infected humans directly reported?

A

1997 in Hong Kong

302
Q

What type of pneumonia refers to one that causes the death of lung tissue cells within the infected pulmonary parenchyma?

A

Necrotizing pneumonia

303
Q

In severe cases, necrotizing pneumonia can result in what?

A

a lung abscess

304
Q

What is characterized as a localized air- and fluid-filled cavity, which is a collection of purulent exudate that is composed of liquified white blood cell remains, protein and tissue debris?

A

Lung abscess

305
Q

What are the major pathologic or structural changes associated with a lung abscess?

A
  • Alveolar consolidation
  • Alveolar-capillary tissue and bronchial wall destruction
  • Tissue necrosis
  • Cavity formation
  • Fibrosis and calcification on the lung parenchyma
  • Bronchopleural fistulas and empyema
  • Atelectasis
  • Excessive airway secretions
306
Q

Lung abscesses most commonly occur as a complication of what?

A

Aspiration pneumonia

307
Q

Anatomically, lung abscesses most commonly develop in what lung regions?

A

Regions that are dependent in the recumbent position. The right lung is more commonly involved than the left.

308
Q

What are some physical examination findings of pneumonia?

A
  • Increased RR
  • Increased temperature
  • Increased HR
  • Decreased chest expansion
  • Chest pain
  • Cyanosis
  • Cough, sputum production and hemoptysis
309
Q

Chest Assessment Findings: Pneumonia

A
  • Increased tactile and vocal fremitus
  • Dull percussion note
  • Bronchial breath sounds
  • Crackles
  • Pleural friction rub
  • Whispered pectoriloquy
310
Q

Radiologic Findings: Pneumonia

A
  • Increased density
  • Air bronchograms
  • Lung abscess and/or air- and fluid-filled cavity
  • Pleural effusion/empyema
311
Q

For bacterial pneumonia, what is the first line of defense? How about for fungal disorders?

A

Antibiotic

Fungal disorder - antifungal agents

312
Q

____________ (also called primary infection stage) follows the patient’s first exposure to the TB pathogen, myobacterium tuberculosis.

A

Primary tuberculosis

313
Q

When does primary TB begin?

A

When the inhaled bacilli implants in the alveoli

314
Q

Unlike in pneumonia, however the lung tissue that surrounds the infected area slowly produces a protective cell wall called a ________.

A

Tubercle, or granuloma

315
Q

As TB progresses, the combination of tubercules and the involvement of the lymph nodes in the hilar region are called _____________.

A

the Ghon complex

316
Q

When tubercles are detected on a chest radiographic, the initial lung lesions are called what?

A

Ghon nodules

317
Q

With a thoracentesis, fluid samples may be examined for what? (8)

A
  • Color
  • Odor
  • RBC count
  • Protein
  • Glucose
  • LDH
  • pH
  • Cytology
318
Q

How long does a tubercle take to form?

A

2-10 weeks

319
Q

State the function of the tubercle.

A

To contain the TB bacilli, thus preventing the further spread of infectious TB organisms.

320
Q

What two things slowly replace the tubercle when the healing process starts?

A

Tissue fibrosis and calcification which cause lung tissue retraction and scarring.

Sometimes the calcification and fibrosis cause the bronchi to distort and dilate — that is, to develop bronchiectasis

321
Q

People with this type of TB do not feel sick or have any TB-related symptoms. They are still infected with TB but do not have clinically active TB.

A

Dormant TB (also called Latent TB)

322
Q

Can people with lament TB/dormant TB infect other people?

A

No.

323
Q

Which type of TB is used to describe the reappearance of TB months or even years after the initial infection has been controlled?

A

Reactivation TB

324
Q

At anytime, TB may become reactivated, especially in what type of patients?

A

Patients with depressed immune systems.

325
Q

Most reactivation TB cases are associated with what following risk factors?

A
  • Malnourished individuals
  • People in institutional housing
  • People living in overcrowded conditions
  • Immunosuppressed patients
  • HIV
  • Alcohol abuse
326
Q

Where is the most common location of disseminated TB?

A

Apex of the lungs

Other oxygen-rich areas in the body include the regional lymph nodes, kidneys, long bones, GI tract, brain and meninges.

327
Q

________ refers to infection from TB bacilli that escape from a tubercle and travel to other sites throughout the body by means of the bloodstream or lymphatic system.

A

Disseminated TB

328
Q

In general, the TB bacilli that gain entrance to the blood stream usually gather and multiply in portions of the body that have what?

A

A higher tissue oxygen tension

329
Q

What does genital TB affect in males and females?

A

Males: prostate gland, epididymis, seminal vesicles and testes.
Females: fallopian tubes, ovaries and uterus

330
Q

The ________ is a frequent site of TB infection, although the hip, knee, wrist and elbow can be involved.

A

Spine

331
Q

What is tubercular meningitis caused by?

A

An active brain lesion TB bacilli into the meninges.

332
Q

What are some TB complications? (6)

A
  • massive hemoptysis
  • pneumothorax
  • bronchiectasis
  • extensive pulmonary destruction
  • malignancy
  • chronic pulmonary aspergillosis
333
Q

When a large number of bacilli are freed into the bloodstream, the result can be the presence of numerous small tubercles — about the size of a pinhead — scattered throughout the body. What type of TB is this?

A

Military TB

334
Q

What are the major pathologic or structural changes of the lungs associated with TB? (7)

A
  • Alveolar consolidation
  • Alveolar-capillary membrane destruction
  • Caseous tubercles or granulomas
  • Cavity formation
  • Fibrosis and secondary calcification of the lung parenchyma
  • Distortion and dilation of the bronchi
  • Increased bronchial secretions
335
Q

In early writings, TB was variously called what?

A
  • Consumption
  • Captain of the Men of Death
  • White plague
336
Q

When was the disease named TB?

A

19th century

337
Q

According to the CDC, there were _______ new cases of TB were provisionally reported in the US in 2017.

A

9093

338
Q

In 2017, an estimated 1 million children became ill with TB. How many died?

A

230,000

339
Q

What is the most effective first line anti tuberculosis agent?

A

Isoniazid

340
Q

Globally, TB incidence is falling at about __% per year.

A

3

341
Q

An estimated _____ lives were saved through TB diagnosis and treatment between 2000 and 2017.

A

54 million

342
Q

Which of the following is often prescribed as a prophylactic daily dose for 1 year in individuals who have been exposed to TB bacilli?

A

Isoniazid

343
Q

At which size wheal is a tuberculin test considered to be positive?

A

Greater than 10 mm

344
Q

Which of the following are known as the first stage of tuberculosis?

A

Primary Infection stage & Primary TB

345
Q

An induration less than _____ is a negative result.

A

5 mm

346
Q

What induration size is considered suspicious and retesting is required?

A

5-9 mm

347
Q

TB: radiographic findings

A
  • Increased opacity
  • Ghon nodule
  • Ghon complex
  • Cavity formation
  • Cavity lesion contain an air-fluid level
  • Pleural effusion
  • Calcification and fibrosis
  • Retraction of lung segments or lobe
  • Right ventricular enlargement
348
Q

What does DOT stand for?

A

Directly Observed Therapy

349
Q

According to the American Academy of Sleep Medicine, sleep disorders can be classified into how many major groups?

A

8

350
Q

What are cardinal features of OSA?

A

Obstructive apneas, hypopneas, and respiratory effort-related arousals, which are caused by the recurring collapse of the upper airway during sleep.

351
Q

_____________ is a disorder characterized by the repetitive stopping or reduction of both airflow and ventilatory effort during sleep.

A

Central sleep apnea

352
Q

When may a snorting sound called fricative breathing be heard?

A

At the end of the apneic periods

353
Q

Central sleep apnea can be classified as what two things?

A

Primary Central Sleep Apnea or Secondary Central Sleep Apnea

354
Q

What are some examples of conditions associated with secondary CSA?

A
  • Cheyne-Stokes breathing (CHF)
  • Medical conditions
  • High altitude periodic breathing
355
Q

____________-related CSA is the most common.

A

Hyperventilation

356
Q

________ is a combination of OSA and CSA.

A

Mixed apnea

357
Q

Clinically, patients with predominantly mixed apnea are classified and treated as having _____.

A

OSA

358
Q

What are some risk factors associated with OSA? (11)

A
  • Excess weight
  • Neck size
  • Hypertension
  • Anatomic narrowing of upper airway
  • Chronic nasal congestion
  • Diabetes
  • Male sex
  • Menopause
  • Family history
  • Smoking
  • Alcohol, sedatives or tranquilizers
359
Q

Pickwickian syndrome that coexists with COPD is known as what?

A

Overlap syndrome

360
Q

What scale is routinely used as a validated measure of daytime sleepiness?

A

Epworth Sleepiness scale

361
Q

Sleepiness must be differentiated from fatigue, which can be semiquantitated with the use of what two things?

A

Fatigue Severity Scale and Visual Analogue Fatigue scale

362
Q

What is frequently used in physician notes to describe abnormalities of the soft palate and uvula?

A

Mallampati classification

363
Q

A specialized sleep test that monitors and records a number of physiologic parameters that occur during sleep.

A

Polysomnography

364
Q

What are other names for non-rapid eye movement (non-REM) sleep?

A

Slow-wave sleep and quiet sleep

365
Q

During non-REM sleep, ventilation becomes slow and regular during which stage?

A

Stage N3

366
Q

Which heart dysrhythmia is associate with CSA?

A

A-fib

367
Q

How do you calculate AHI?

A

Number of apneas and hypopneas divided by TST.

368
Q

_______ OSA is defined as an AHI between 5 and 15 respiratory events per hour of sleep.

A

Mild

369
Q

_______ OSA is defined as an AHI between 15 and 30 respiratory events per hour of sleep.

A

Moderate

370
Q

_______ OSA is defined as an AHI of more than 30 respiratory events per hour of sleep and/or an SpO2 below 90% for more than 20% of the TST.

A

Severe

371
Q

CVP measures which side of the heart?

A

Right

372
Q

PCWP measures which side of the heart?

A

Left

373
Q

What are some radiologic findings of OSA?

A

Right-or left-sided heart failure

374
Q

_________ is particularly effective in obese OSA patients who demonstrate CO2 retention.

A

BIPAP

375
Q

The EPAP portion of BIPAP usually functions as ________.

A

PEEP

376
Q

Normally, REM sleep constitutes about what percentage of the TST?

A

20-25%

377
Q

During REM sleep, there is paralysis of the:

A

arm muscles, upper airway muscles, leg muscles and intercostal muscles

378
Q

How long do normal periods of apnea during REM usually last?

A

15-20 seconds

379
Q

Pneumonia or pneumonitis with consolidation is the result of an inflammatory response that primarily affects what?

A

The gas exchange of the lungs

380
Q

________ simultaneously detects myobacterium tuberculosis and rifampin resistance directly from the patient’s sputum.

A

The Xpert MTB/RIF assay

381
Q

What is the most widely used TB test?

A

Mantoux tuberculin skin test

382
Q

The mantoux skin test consists of a intradermal injection of a small amount of a ______.

A

purified protein derivative (PPD) of the tuberculin bacillus

383
Q

What should be stressed about a mantoux skin test?

A

A positive does not mean the patient has active TB, only that the patient has been exposed to the bacillus and has developed cell-mediated immunity.

384
Q

Which acid fast stain reveals bright red acid-fast bacilli against a blue background?

A

Ziehl-Neelsen stain

385
Q

Which acid-fast stain reveals luminescent yellow-green bacilli against a dark brown background?

A

Fluorescent acid-fast stain, it’s easier to read

386
Q

How long does it take for results of a sputum culture to come in?

A

6 weeks

387
Q

_______ is a whole-blood test used for diagnosing M. tuberculosis infection, including latent TB infection.

A

QuantiFERON-TB Gold Test

388
Q

The QuantiFERON-TB mixture is allowed to incubate for how long?

A

16-24 hours

389
Q

After the incubation period of the QuantiFERON test has passed, what is it measured for?

A

The presence of interferon-gamma (IFN-gamma).

390
Q

What is the most common and arguably the most effective treatment for OSA?

A

CPAP

391
Q

During what sleep stage does the EEG become more irregular and is composed of predominantly of theta waves, intermixed with sudden bursts of sleep spindles and one or more K complexes?

A

Stage N2 (light sleep)

392
Q

During what stage does the EEG show beta waves and high-frequency, low-amplitude activity?

A

Eyes open-wake (stage W)

393
Q

During what stage does the EEG show low-voltage, mixed-frequency activity, alpha waves and theta waves?

A

Stage N1 (light sleep)

394
Q

During stage N3, the EEG shows more than ___% delta waves.

A

50

RET1293 (10 decks)

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