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Cadiopulmonary Medicine > The Pathophysiologic Basis for Common Clinical Manifestation Ch.3 > Flashcards

The Pathophysiologic Basis for Common Clinical Manifestation Ch.3 Flashcards

1
Q

An individual’s normal breathing pattern is composed of

A

tidal volume (Vt), ventilatory rate, and inspiration- to- expiration (I/E ratio)

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2
Q

In a normal adult Vt is about ______ or ____ to ____

A

500mL (7 to 9 mL/kg)

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3
Q

Ventilatory rate is

A

12-20

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4
Q

I/E is about

A

1:2

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5
Q

_________ is defined as the “breathlessness” or “SOB” or the labored/ difficult breathing felt and described ONLY by the patient

A

Dyspnea

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6
Q

Common types of dyspnea include

A
  1. positional dyspnea
  2. cardiac dyspnea
  3. exertional dyspnea
  4. paroxysmal nocturnal dyspnea
  5. renal dyspnea
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7
Q

Positional dyspnea occurs only when pt is

A

in the reclining position; orthopnea

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8
Q

Cardiac dyspnea is_________ breathing, caused by _______ disease

A

labored breathing caused by heart disease (CHF)

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9
Q

Exertional dyspnea is provoked by

A

physical exercise

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10
Q

Paroxysmal nocturnal dyspnea is a form of respiratory distress related to

A

posture (especially reeling while sleeping).

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11
Q

Proxymal nocturnal dyspnea is associated with what diseases?

A

CHF with pulmonary edema

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12
Q

Renal dyspnea is difficulty in breathing as a result of

A

kidney disease

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13
Q

During normal periods of eupnea, the individual has no sensation of difficult breathing. What matches?

A

Demand- to- breath matches capability- to- breath

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14
Q

During periods of significant exercise, normal individual’s capability - to- breathe may be challenged to meet the
As ____________ consumption increases

A

increased demand- to -breath as oxygen consumption increases

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15
Q

Modified Medical Research Council (mMRC) Questionnaire is used for?

A

Accessing the Severity of Breathlessness in those who can speak

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16
Q

The Borg Dyspnea Scale is used in patients who

A

cannot communicate b/c of mouthpiece, ET tubes, tracheotomies

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17
Q

Abnormal ventilatory patterns happens when

A
  1. the anatomic alterations of the lungs associated w/ a specific disorder
  2. the pathophysiologic mechanism that develop b/c of the anatomic alterations
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18
Q

To evaluate and asses the various abnormal ventilatory patterns, the following ventilatory must first be understood (5)

A

-Lung compliance
-airway resistance
-peripheral chemoreceptors
-central chemoreceptors
-pulmonary reflexes

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19
Q

The ease with which the elastic forces of the lungs accept a volume of inspired air is known as

A

lung compliance

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20
Q

Compliance determines

A

how much air in liters the lungs will accommodate for each centimeter of water pressure change in distending pressure

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21
Q

Lung compliance can either

A

increase or decrease

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22
Q

Increased lung compliance is good except in

A

emphysema

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23
Q

Emphysema is when lungs have lost all

A

elasticity (hyperinflation)

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24
Q

Normal lung compliance is

A

0.1 L/cm H20

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25
Q

CL=

A

change in volume (L)/ change in pressure (cmH20)

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26
Q

Decreased lungs compliance means lungs are

A

stiff and cannot expand

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27
Q

Decreased lung compliance is seen in

A

asthma attacks, pulmonary fibrosis, ARDS, pulmonary edema, PNA

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28
Q

The pressure difference between the mouth and the alveoli divided by the flow rate

A

Airway resistance (Raw)

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29
Q

The rate at which a certain volume of gas flow through the airways is a function of…

A

pressure gradient and resistance created by the airways to the flow of gas

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30
Q

Raw =

A

change in pressure( cm H20)/ V(L/s)

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31
Q

Normal Raw in TB tree is about

A

1.0 to 2.0 cm H20/ L/ s

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32
Q

Decreased resistance is _____
Increased resistance is _____

A

good/ bad

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33
Q

What can also increase Raw?

A

Secretions

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34
Q

________ is defined as the force multiplied by the distanced move

A

work

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35
Q

Work =

A

force x distance

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36
Q

Peripheral chemoreceptors are activated by_______ and are triggered when Pa02 falls below ______

A

hypoxemia; 60

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37
Q

A decreased arterial oxygen level (hypoxemia) is a result of decreased (3)

A

ventilation-perfusion ration (V/Q), pulmonary shunting, and venous admixture

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38
Q

When the diaphragm becomes significantly depressed or comprised what is activated?

A

Accessory muscles of inspiration

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39
Q

The major accessory muscles of inspiration are

A
  • Scalenes
  • Sternocleidomastoids
  • Pectoralis major muscle groups
  • Trapezius muscle groups
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40
Q

This is activated when Raw become significantly elevated

A

Accessory muscles of expiration

41
Q

The major accessory muscle of expiration are

A
  • Rectus abdominus
  • External oblique
  • Internal oblique
  • Transversus abdominis
42
Q

_______-____ ___________ occurs in patients during the advanced stages of obstructive pulmonary disease

A

Pursed- lip breathing

43
Q

The positive pressure (back pressure) provides the airways w/ some stability which offsets

A

airway collapsed and air trapping

44
Q

This may be seen in patients with severe restrictive lung disease such as PNA and ARDS (mainly seen in infants)

A

substernal and intercostal retractions

45
Q

Intercostal is the

A

skin in between the ribs

46
Q

Substernal is

A

below the sternal

47
Q

Superclavicular is

A

above the clavicle

48
Q

Retractions mean

A

the skin sinks down into bony structures when trying to breathe

49
Q

Severe resistance to taking a deep breath is a symptom of pleuritic pain is called (❤️ pillow)

A

splinting

50
Q

Usually described as a sudden sharp or stabbing pain

A

pleuritic chest pain

51
Q

pleuritic chest pain happens in what diseases (5)

A

PNA
pneumothorax
lung cancer
plueral effusion
TB

52
Q

____ __________ _______ pain is described as constant pain that is usually located centrally

A

Nonpleuritic chest pain

53
Q

Nonpleuritic chest pain happens in (4)

A

myocardial ischemia
pulmonary hypertension
local trauma of chest cage,
Esophagitis

54
Q

The inspection of the pt’s extremities should include (4)

A

-Altered skin color (e.g cyanotic, pale, red, purple)
- digital clubbing
- peripheral edema
- distended neck veins

55
Q

The termed is used to describe the blue-gry or purplish of the mucous membrane, finger tips and toes whenever the blood in these areas contains 5 g/dL of reduced hemoglobin.

A

Cyanosis

56
Q

Is characterized by bulbous swelling of the terminal phalanges of the fingers and toes.

A

Digital clubbing

57
Q

Peripheral edema is seen in pts with

A

CHF

58
Q

Flow from the major veins of the chest that returned blood to the right side of the heart may be compromised is called (neck)

A

Distended neck veins (Jugular venous distention)

59
Q

__________ _________ production is commonly seen in respiratory disease that cause an acute or chronic inflammation of the TB tree

A

Excessive sputum

60
Q

What should be assessed in sputum

A

Sputum volume, appearance, viscosity, and odor

61
Q

Acute sputum may be a cause of the

A

cold or flu

62
Q

Chronic sputum may be seen in

A

cystic fibrosis , COPDers

63
Q

Coughing up blood or blood tinged sputum from the TB tree is called

A

hemoptysis

64
Q

Vomitting blood is called

A

hematemesis

65
Q

A sudden audible explosion of air from the lungs is called

A

cough

66
Q

For a cough to be affective you need 3 things. What are they?

A
  1. deep inspiration
  2. partial closure of the glottis
  3. forceful contraction of accessory muscle of expiration to expel air from the lungs
67
Q

What are some causes for a non productive cough?

A
  • irritation of the airway
    -inflammation of the airways
    -mucous accumulation
    -tumors
    -irritation of the pleura
68
Q

For a productive cough the RT should access (3)

A

-Is the cough strong or weak
- Is it a loud cough
-Is sputum being coughed up? If so how much , color and odor

69
Q

What is the average total compliance of the lungs and chest wall combined?

A

0.1 L/cm H20

70
Q

When lung compliance decreases, what is normally seen?

A
  • Tidal volume usually decreases
  • Ventilatory rate usually increases
71
Q

What is the normal airway resistance in the TB tree?

A

1.0 to 2.0 H2o/L/s

72
Q

When the systemic blood pressure increases, the aortic and carotid sinus baroreceptors initiate reflexes that causes what to decrease

A
  • Decreased ventilatory
  • Decreased heart rate
73
Q

What is the anteroposterior- transverse chest diameter ratio in the normal adult?

A

1:2

74
Q

What muscles originate from the clavicle? (2)

A
  • Sternocleidomastoid muscles
  • Pectoralis major muscles
75
Q

Which of the following is associated with digital clubbing?

A
  • Chronic infection
  • Local hypoxemia
  • Circulating vasodilators
  • Arterial hypoxemia
76
Q

Which of the following is associated with pleuritic chest pain?

A
  • Lung cancer
  • PNA
  • Tuberculosis
77
Q

Signs of dyspnea include

A

-labored breathing
-hyperventilation
-tachypnea
-retractions of intercostal spaces
-use of accessory muscles
-distressed facial expression
-flaring of the nostrils
- paradoxical breathing
-gasping

78
Q

Borg dyspnea scale

A
  1. no SOB
    0.5 slight SOB
    1
  2. Mild SOB
  3. Moderate SOB
    4
    5.Strong or hard breathing
    6
  4. Sever breathing
    8
    9
  5. SOB so severe I need to stop and rest
79
Q

Abnormal ventilatory patterns that occur suddenly (minutes to hours maximum) are classified as

A

acute onset conditions

80
Q

Abnormal ventilatory conditions that develop slowly (days to months to years) are classified as

A

chronic conditions

81
Q

__________ _______ pain intensifies during deep inspiration and coughing and diminished during breath holding and splinting

A

Pleuritic chest pain

82
Q

Is generally not worsened by deep inspiration

A

Nonpleuritic chest pain

83
Q

When lung compliance decreases ventilatory rate __________ and ________ ________ increases

A

decreases and tidal volume (vt)

84
Q

Common measurements that can be calculated from a single forced vital capacity (FVC)

A

FEVt
FEV1/FVC ratio
FEF2 200-1200
FEF 25%-75%
PEFR

85
Q

A decreased DLCO is a hallmark clinical manifestation in

A

emphysema

86
Q

In obstructive DLCO is decreased only in _______ and normal in _________

A

emphysema; restrictive

87
Q

The ____________ ____________pressure the pt is able to generate against a closed airway and is recorded as a ________ number in either cmH20 or mm

A

The maximum inspiratory pressure (MIP) ; negative

88
Q

In a normal adult the MIP is

A

-80 to 100 cm H20

89
Q

A forceful expiratory effort against an occluded airway and is reordered as a _______ number in either cm h20 or mm

A

Maximum expiratory pressure (MEP); positive

90
Q

The adult normal MEP is greater than

A

100 cm h20 males
80 cm h20 in females

91
Q

What is the PEFR in the normal healthy woman 20-30 y/o

A

450 L/min

92
Q

A restive lung disorder is confirmed when the

A
  • FEV1 is decreased
  • FEV1/FVC ratio is normal or increased
93
Q

In obstructive lung disorder

A

-RV is increased
-VC is decreased

94
Q

Under normal conditions the average DLCO value for the resting man is

A

25 mL/min/mm hg

95
Q

What is the normal percentage of the total volume exhaled during an FEV1

A

83%

96
Q

Which can be obtained from a flow- volume loop?
1.FVC
2.PEFR
3.FEVt
4.FEF 25%-75%

A

1,2,3,4

97
Q

An obstructive lung disorder is confirmed when the:
1.FEV1 is decreased
2. FVC is increased
3. FEV1 is increased
4. FEV1/FVC ratio is decreased

A

1 and 4

98
Q

What Anatomic alterations of the lungs is or are associated w/. restricted lung disorder

A

Atelectasis
Consolidation

Cadiopulmonary Medicine (24 decks)

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