Question Answer
In fungal diseases of the lung, tactile, and vocal fremitus would more than likely be decreased FALSE
Which of the following are clinical manisfestations that may be associated with TB Dull precussion note, bronchial breath sounds, radiographic evidence of cavity formation
Clinical findings associated with lung abscess are Decreased FEVT and Foul smelling brown or gray sputum
When lung abscess is caused by methicillin-Anatomic and physiologic differences in the pediatric respiratory tractsuseptible strains of Staph aureus, nafcillin or oxacillin may be used to treat it TRUE
In the wet drowning victim a normal chest radiograph in the first 24 hours rules out the possiblity of alveolar-capiliary deterioration FALSE
A positive tuberculin test begins with a wheal of what size 10mm or greater
In wet drowning, when fluid is initially inhaled, the bronchi ___________ in response to a _____________ reflex. constrict, parasympathetic-mediated
When a pulmonary embolus lodges itself in the pulmonary circulation there is an increase in blood flow distal to the obstruction1 FALSE
Which of the following is by far the most common source of pulmonary embolism Blood clot
Pulmonary edema is considered an obstructive pulmonary disorder False
All of following are considered major pathologic or structual changes associated with pulmonary edema frothy pink secretions throughout the tracheobroncial tree, alveolar atelectasis and intersitial edema
Because no carbon dioxide or oxygen exchange occurs beyond a pulmonary embolus, dead space and wasted ventilation increases TRUE
_______________ refers to infection from bacilli that escape from a tubercle and move to sites other than the lungs Disseminated tuberculosis and extrapulmonary tuberculosis
Major pathologic and structual changes occuring with wet drowning include frothy white and pink secretions t/o the tracheobroncial tree, intersitial edema, larngospasm and bronchospasm
TB bacilli are almost exculsively transmitted within aerosol droplets, produced by the coughing, sneezing, or laughing of an individual with active TB True
Graduated compression stockings used to prevent pulmonary embolism, help the veins and muscles move more blood more efficiently by squeezing the patient’s arm false
What happens to alveolar surface tension in pulmonary edema it increases
which of the following may be pathologic or structual changes to the lungs associated with pulmonary embolism alveolar atelectasis, pulmonary infarction, blockage of the pulmonary vascular system, possible release of cellular mediators leading to bronchoconstriction
When a drowning victim with fixed and dilated pupils has been submerged in cold water for 30 minutes the prognosis is always poor. true or false? false
Which of the following are clinical findings associated with pulmonary embolism Increased density in infracted areas on radiograph, increased pulmonary artery pressure, decreased DO2
In QFT-G testing an elevated IFN-gamma level is diagnostic of TB, true or false? TRUE
Echinocandins is a relatively new class of antifungal agnets used to treat fungal infections from Aspergillus and Candida, True or False? TRUE
When is it necessary to intubate and mechanically ventilate a drowning victim? The patient is not breathing spontaneously or The patient is breathing spontaneously with a PaO2 <60 mmHg on an FIO2 0.40
Which of the following is the most common fungal infection in the United States? Histoplasmosis
Apena associated with near wet drowning is directly related to the length of time the victim is submerged (i.e. the longer the submersion the more likely the victim is w/o spontaneous respirations) TRUE
Pulmonary angiography is an extremly accurate test for determining the presence of pulmonary embolism? true or false TRUE
Chest assessment findings commonly show which of the following directly over a lung abscess? pleural friction rub, dull percussion note, bronchial breath sounds, dimished breath sounds
The most commonlyu used tuberculin skin test is the Mantoux test
Colloid osmotic pressure is called oncotic pressure TRUE
Which of the following is/are considered first-line agent(s) of tuberculosis for the entire 9 month protocol Isoniazid and Rifampid
H Capsulatum is commonly found in the soil that is near chicken houses, pigeon lofts, and barns TRUE
The chest radiograph for lung abscess will more than likely show decreased opacity, cavity formation and pleural effusion FALSE
A necrosis of lung tissue that, in severe cases leads to a localized air and fluid-filled cavity is the definition of Lung Abscess
During treatment the victim’s body temperature may be increased using which of the following IV administration of heat solutions, heated lavage to peritoneal spaces, heating blankets, heating the victim’s inspired air
During wet drowning cardiogenic pulmonary edema results from fluid in the pulmonary capillaries moving into the perivascular spaces FALSE
Vancomycin is commonly used to treat methcillin-resistant strains of S Aureus TRUE
What is considered tthe most common cause of pulmonary edema? increased capillary hydrostatic pressure
Risk factors associated with causing pulmonary embolism realted to venous stasis include Inactivity/prolong sitting, Excesive hip or abdominal operations
which of the following fungal infections are considered opportunistic pathogens seen in patients with HIV infection Cryptococcus and Aspergillius
Which of the following are considered common causes of cardiogenic pulmonary Excessive fluid administration, left ventricle failure, and mitral valve disease
Which of the following is considered a thrombolytic agent used in treating pulmonary embolism Streptokinase
Which of the following are clinical findings that may be associated with pulmonary edema Decreased pH and increased PaCO2 in severe edema, Decreased cardio outout, Increased shunting
At onset, those portions of the lungs affected by pulmonary embolism will have a _______ High V/Q ratio
Medications and procedures used to help manage pulmonary edema include Positive inotropic agents, diuretic agents, ACE inhibitors
The following are pathologic or structural changes associated with lung abscess Atelectasis, cavity formation, tissue necrosis, fibrosis and calcification of the lung parenchyma
Which of the following anatomic alterations of the lungs are associated with lung abscess Cavity formation, alveolar consolidation, Bronchopleural fistula, Atelectasis, excessive airway secretions
Which of the following should be done when treating a near drowning victim during transport? Administer the highest quality CPR possible, Conserve the victim’s body heat, Administer 100% oxygen
Which of the following are clinical findings in near wet drowning victim Tachypnea, Decreased lung compliance, An increase in intra-pulmonary shunting
What is the normal hydrostatic pressure in the pulmonary capillaries that tends to move fluid out of the pulmonary capillaries 10-15 mm Hg
Which of the following factors favor a positive prognosis in cold-water near drowning?? The colder the water the better
The different types of drowing include: Wet drowning, near drowing, dry drowning
After being inhaled, fungal spores may reach the lungs where ________ and ________ engulf them. Macrophages and Polymorphonuclear leukocytes
Coccidioidmycosis is also known as Desert fever
Which of the following is considered the drug of choice for most fungal infections? IV Amphotercin B
Predisposing factors that frequently lead to the aspiration of gastrointestinal fluids (and anaerobes) are usually related to which of the following? General anesthesia, head trauma, cerebrovascular accident, seizure disorder, alcoholic abuse
Coughing and hemoptysis due to a pulmonary embolism can be the result of plasma moving across the alveolar capillary membrane into the alveolar spaces, increased pulmonary hydrostatic pressure, red blood cells moving across the alveolar capillary membrane
Which of the following may be implicated in causing ILD? Berylliosis, Silicosis, Goodpasture’s syndrome, Coal dust, and Radiation therapy
Is pneumonthorax considered an obstructive disorder? NO
Kyphosis is a posterior curve of the spine
The main goal of managing interstitial lung disease is directed at controlling the inflammation associated with the various disorders TRUE
What term is used to describe the accumulation of gas (free air) in the pleural space Pneumothorax
In the most severe cases a chest tube is commonly used to treat a pneumothorax. since air rises the tube is normally placed posteriorly near the base of the lung FALSE
Squamous cell carcinoma originates from the basal cells of the bronchial epithelium
Surgical resection is usually an option for patients with NSCLC up to stage IIIA TRUE
In patients suffering from kyphoscoliosis oxygen therpay is used to; treat hypoxemia, decrease the work of breathing and decrease myocardial work. Hypoxemia caused by capillary shunting is often refractory to oxygen therapy TRUE
Which of the following are considered major pathological or structural changes associated with pleural effusion Compression of the great veins, Atelectasis, Decrease venous return of blood to the heart, lung compression
NONE of the following are clinical manifestations below that are normally assoicated with kyposcoliosis Decreased heart size seen on chest radiograph due to cor pulmonale, Increased FVC, Decreased pulmonary shunting, Hyperinflated areas seen on chest radiograph where lung compression is evident, decreased CVP and PA
Polycythemia and cor pulmonale are both late findings associated with kyphoscoliosis True
During the chronic stages of ILD the inflammatory state is charcterized by edema and the infiltration of a variety of RBCs in the alveolar walls FALSE
NONE of the of the following are considered clinical findings associated with pneumothorax Decreased VC, Decreased FRC, Increased CVP, and Decreased cardio output
Which of the following can be used in managing/ treating pleural effusion Chest tube drainage, pleurodesis, Hyperinflatio protocol, Thoracentesis, Oxygen therapy protocol
When gas (free air) enters the pleural space the visceral and parietal pleura bond together FALSE
Which of the following are also used to describe interstitial lung disease Pulmonary fibrosis and Pneumoconiosis
Because acute changes superimposed on chronic ventilatory failure are rarely seen in the patient with ILD the use of mechanical ventilation is never required FALSE
A mediastinal shift to the unaffected side may be associated with a pleural effusion TRUE
The following are considered major pathologic or structural changes associated with ILD Cavity formation, Honeycombing, and Bronchospasm
Identify the clinical manifestations that may be assciated with pleural effusion Increased pulmonary shunting, Increased CVP and Increased PVR, Blunting of the costophrenic angles and the pressence of a meniscus sign on chest radiograph, depressed diaphragm
A pnumothorax that is the result of a specific diagnostic or therapeutic procedure is referred to as a traumatic pneumothorax FALSE
Fail chest is considered a obstructive pulmonary disorder False
Trauma to the neck commonly causes which of the following Chylothorax
Systemic lupus erythematosus presents as a multisystem disorder mainly involving the skin and joints. However, the lungs are involved in about _______ of the cases 50% to 70%
Surgery is normally the best option for those patients who have NSCLC in both lungs up to an including stage IV disease FALSE
Thoracentesis may be useful both therapeutically and diagnostically in the management of pleural effusion TRUE
Systemic diseases associated with ILD include Scleroderma
Which of the following are considered causes of flail chest? Motor vehicle accident, Industrial accident, Direct compression by a heavy object
What value is used as a benchmark for not being able to view a pleural effusion on an upright chest x-ray? when the effusion is less than 300ml
The hypoxemia associated ILD is normally caused by Capillary shunting,Alveolar thickening, fibrosis
What type of radiographic technique should be used when a pleural effusion is difficult to determine because of the obliteration to one or both diaphragms by atelectasis and or pulmonary infiltrates Lateral decubitus view
Which of the following describes ILD It can be both a restrictive and an obstructive disorder
The clinical manifestations associated with Kyphoscoliosis are based on the clinical scenarios activated by which of the following Excessive bronchial secertions and Atelectasis
Which of the following seem to be possible causes of Kyposcoliosis Neuromuscular disorders, Hormonal imbalance, Tumors, Bone infections
A disorder where there are double fractures of at least three or more adjacent ribs causing the thoracic cage to become unstable is specifically referred to as____________ A Flail chest
The presence of blood in the pleural space is best known as _________ and can be confirmed by checking___________ Hemothorax, Hematocrit
The most common cause of plerual effusion is congestive heart failure
In a patient with a pneumothorax when is the evacuation of air from the pleural cavity usually necessary When it is larger than 20%
Microscopic examiniation of the thickened septa in asbestosis reveals brown or orange baton-like structures
What type of breath sounds are produced by a pneumothorax Decreased breath sounds
An increased respiratory rate seen in patient’s with kyposcoliosis may be the result of which pathophysiologic mechanisms? Decreased lung compliance/increased respiratory rate relationship, Stimulation of perpheral chemoreceptors, pain/anxiety, Hypoxemia
What is the term specifically used to describe a pneumothorax that results in a one-way valve allowing gas to enter the pleural space on inspiration but prohibiting it from leaving on expiration tension/ closed pneumothorax
In order to evacuate air from the pleural cavity and re-expand a lung affected by a pneumothorax, the suction should not exceed -12cmH2O
Major causes of a transudative pleural effusion include Hepatic cirrhosis, Pulmonary embolus, Neprhrotic Syndorme
Which type of lung cancer is most associated with cigarette smoking and carries with it the worst prognosis Oat-cell carcinoma
Treatment/management options for those patients with small-cell lung cancer usually include: Supportive care, Chemotherapy, Radiation therapy
Which of the following is/are non-small-cell lung cancers Squamous carcinoma, Adenocarinoma
Which of the following may be associated with Kyphoscoliosis? Rhonchi, Dull percussion note, Bronchial breath sounds
A spontaneous pneumothorax is secondary to which of the following disorders COPD, TB, Pneumonia
Respiratory care treatment options for the patient diagnosised with Lung CA include: O2 therapy, Aersolized medication protocol, Bronchopulmonary hygiene, Lung expansion therapy
Common surgical procedures suggested for the patient with NSCLC include: Lobectomy, pneumonectomy, wedge resection
Large cell carcinoma is an undifferntiated form of lung cancer
Fill in the blanks: In severe cases of pneumonthorax the great veins can become _______ and cause ________ return to the heart to the heart to__________. Compressed, venous, diminished
Which of the following are considered major pathological or structural changes associated with bronchogenic carcinoma Airway obstruction from blood, mucus accumulation or a tumor projecting into a bronchus, Atelectasis, Pleural effusion, and cavity formation
Which of the following may be considered small-cell lung cancers Oat-cell carcinoma
Major pathological or structural changes of the lungs associated with Kyphoscoliosis include Mediastinal shift, Atelectasis, Lung compression due to thoracic deformity
Select the statements below that describe the TNM classification system The letter ” N” in the TMN system represents lymph node involvement, The letter “M” in the TMN system denotes the extent of metastasis, Roman numerals assist in identifying the different stages of cancer with ” IV” indicating the most advanced stage
Select the clinical manifestations that can be associated with ILD: Decreased PEFR, Pitting edema and distended neck veins, Increased pulmonary shunting, CXR exhibiting cavity formation, granulomas and/or bilateral reticulonodular appearance
which of the following are used to managed/ treat flail chest Routine bronchial hygiene, Oxygen therapy protocol, Medication for pain management, volume controlled ventilation with PEEP to stalize the flail
Which of the following normally help to determine the prognosis for a victim of a fire Age of the victim, Duration and extent of smoke exposure, chemical composition of the smoke being inhaled
the cause of Myasthenia Gravis appears to be related to circulating antibodies that disrupt the transmission of acetylcholine TRUE
What is the therapeutic goal of low tidal volume ventilation in ARDS Decrease barotraumas, reduce overdistention of the lungs
A phrenic pacemaker is normally recommended for the patient suffering from obstructive sleep apnea FALSE
Direct thermal injuries normally do not occur below the level of the larynx execpt in the rare instance of steam inhalation TRUE
The half-life of CO in the patient breathing room air at 1 atm is approximately 5 hours
Obstructive sleep apnea appears to be the most severe in what sleep position supine postition
Hyperbaric oxygen therapy is always used for the elimination of CO in the smoke inhalation victim FALSE
Thermal injury occurring to the distal airways post inhalation of steam results COP, BOOP
The thymus gland in many myasthenic patients appears to be the source of anti-Ach receptor antibodies TRUE
Which of the following medications are useful in the treatment of blood pressure and cardiac disturbances for the patient with Guillain-Barre syndrome Nipride, Atropine, Phentolamine
Even when diagosed early, patients suffering from Guillain- Barre syndrome have a poor progonosis for recovery FALSE
The diagnosis of sleep apnea is made based on patients who have more than five episodes of apnea per hour. These episodes occur only in non-REM sleep over a 3 hour period FALSE
Which of the following are considered etiologic factors associated with ARDS Drug overdose, shock, Infections, Oxygen toxicity, Aspiration
The distal airways and alveoli are usually protected from thermal injury by reflex laryngospasm, glottic closure
The diagnosis of sleep apnea may be confirmed by confirmed by polysomnographic sleep studies TRUE
ARDS is considered an obstructive lung disorder FALSE
The etiology of myasthenia gravis appears to be associated _________ antibodies that block nerve impulse transmission at the neuromuscular junction IgG
Select the signs and symptoms below that may be associated with obstructive sleep apnea Shortness of breath following abrupt awakenings, Nocturnal enuresis, Morning headache, Snoring loudly
Treatment for cyanide poisoning may include IV sodium thiosulfate and inhalation of amyl nitire TRUE
Serum levels of IgM antibodies against myelin glycolipid have been found to be ________ in the patient with Guillain-Barre syndrome elevated
Mixed sleep apnea is a combination of central and obstructive sleep apnea and commonly begins as OSA FALSE
Third spacing fluid shifts associated with body surface burns can result in intravascular volume loss (hypovolemia) TRUE
The 3 Primary types of sleep apnea are classified as Obstructive sleep apnea, Mixed sleep apnea I, Central sleep apnea
Chest xray findings associated with ARDS include Increased opacity and Ground glass appearance
CO poisoning can greatly reduce oxygen transport because its affinity for hemoglobin is 400 times greater than that of oxygen FALSE
Myasthenia gravis is more common in younger men FALSE
Select the appropriate treatment for the patient who has recently inhaled hot gases and exhibits signs of impending UAO Endotracheal intubation
The signs and symptoms of thermal injury associated with smoke inhalation can always be identified immediately, especially when extensive body surface burns are present FALSE
Select from the list below the major structual or pathologic lungs changes that may be associated with ventilatory failure accompanying myasthenia gravis Atelectasis, Airway obstruction, Alveolar consolidation, Accumilation of mucus
Most thermal injuries affect the distal airways and alveoli FALSE
The use of plasmapheresis in treatment of Guillian-Barre syndrome is aimed at the removal of damaged antibodies from the patient’s blood plasma and has shown to be effective in reducing the antibody titer during early stages of the disease TRUE
Which of the following are considered beneficial in managing the patient with Guillian- Barre syndrome Frequent measurement of the patient’s VC, BP, and NIF, Heparin therapy, Measurement of the patient’s oxygen saturation, Plasmapheresis, Aterial blood gas measurement
What techniques may be useful in the diagnosing of myasthenia gravis CT and/or MRI, Blood analysis, Electromyography, Evaluating the patient’s clinical history, Endrophonium testing, Neurologic examination
Coricosteriod therapy has been shown to be effective in the treatment of Guillain-Barre ayndrome and shorten False
What chronic neurologicval disorder is characterized by the interference of acetylcholine between the axonal terminal and the receptor sites of voluntray muscle Myathenia Graivs
Which of the following describes obstructive sleep apnea (OSA) Its cause is an anatomic obsruction of the upper airway in the presence of continued ventilatory effort
The chest radiograph associated with smoke inhalation is usually normal during the early stage
All of the following are considered major pathological or structual changes associated with ARDS Alveolar consolidation, Atelectasis, Intra-alveolar hyaline membrane formation
Which of the following describes the strategy of reducing the tidal volume thereby allowing the patient’s PaCO2 to increase in order to protect the lungs from high airway pressures Permissive hypercapnia
Apnea is defined as the cessation of breathing for 10 seconds or longer
a burn identified as full thickness of the skin including tissue beneath the skin describes a 3rd degree burn
Pathologic changes in the distal airways and alveoli mainly caused by irritating and toxic gases are commonly associated with smoke inhalation
Sleep apnea that occurs with the cessation of inspiratory efforts as the result of the respiratory centers of medulla failing to send signals to the respiratory muscles is known as CSA
The following events may occur during REM sleep Negative pressure generated by the diaphragm produces paradoxical motion of the rib cage, Loss of muscle tone in the upper airway can result in airway obstruction, the heart rate can become irregular
Treatment modalities for managing sleep apnea may include UPPP, Nocturnal CPAP used to treat OSA, Phrenic nerve pacemarker used to treat central sleep apnea
The mucosa of the tracheobronchial tree very often becomes necrotic and sloughs ________ post inhalation of smoke 3-4 days
Select the clinical finding below that may be associated with Guillain-Barre syndrome Negative inspiratory force (NIF) measurement is decreased
Correct sequence of events resulting in the manifestation of ARDS Pulmonary capillaries engorgement post-injury, Increased permeability of the alveolar-capillary membrane, Evidence of intra-alveolar edema and hemorrhage, decreased surfactant, Alveolar collapse and atelectasis
Which of the following are true regarding NON-REM sleep? Non-REM sleep consists of 4 separate stages of sleep, Non-REM sleep usually lasts 60 to 90 minutes, It is possible for an individual to move directly into REM sleep from any of the 3 stages of Non-REM sleep
A burn identified as superficial to deep thickness describes a 2nd degree burn
Which of the following may anti-cholinesterase agents may be used to help treat myasthenia gravis Prostigmin, Pyridostigmine, Mestinon, Neostingmine
During periods of sleep apnea the heart rate ______ then _______ after termination of the apne decreases then increases
Which of the following are clinical findings that may be associated with myasthenia gravis Decreased tidal volume, Increased pulmonary shunting, Decreased DO2
The onset of Guillain-Barre syndrome usually occurs ____________ 1 to 4 weeks after a febrile episode such as a mild upper respiratory infection
The initial care of the burn patient should include assessment of the following Cardiovascular status, Respiratory status, Percentage of body burned, Patient’s airway
Which of the following appear to attack and strip off the myelin sheath of the peripheral nerves and leave selling/fragmentation of the neural axon in Guillain-Barre syndrome Lymphocytes and Macrophages
The current ventilation strategy for the majority of patients with ARDS suggests the use of initial tidal volumes of 5 to 7 ml/kg, Ventilatory rates as high as 35bpm in order to maintain adequate minute ventilation, low tidal volumes and high respiratory rates, PEEP and CPAP to reduce atelectasis
Question Answer
What is the primary structure that undergoes change in Chronic Bronchitis? The conducting airways
In Chronic Bronchitis the ______ _____ are enlarged bronchial glands
What bacteria is found in the tracheobronchial tree of patients with chronic bronchitis? H-Influenza and Streptococcus
In a PFT, a patient will show a (increase/decrease) in Expiratory Reserve Volume? Decreased ERV
What is the trade name of the sympathomimetic agent albuterol? Proventil and Ventolin
What is the trade name of the parasympatholytic agent ipratropium bromide? Atrovent
What is produced by bronchspasms, a cardinal finding of bronchial asthma and usually heard as high-pitched sounds? Wheezing
Which abnormal breathing pattern is associated with diabetic acidosis? Kussmal’s respiration
What 4 things are associated with digital clubbing? Chronic infection,local hypoxia, vasodilators and arterial hypoxia
Which muscles inserts into the xiphoid process and into the 5th, 6th and 7th ribs? Rectus abdominis muscle
Which muscles originate from the clavicle? Sternocleidomastoid and Pectoralis major
Which of the following would a dull percussion note be heard? Pleural Effusion, Atelectasis, Consolidation or Pneumothorax Pleural Effusion, Atelectasis, & Consolidation
What 3 things are associated with stridor? High pitched sound, Obstruction in the trachea and Glotic edema
Signs of inadequate oxygenation (3)? intercostal retractions, increased energy, combativeness or cyanosis Intercostal retractions, combativeness and cyanosis
Which pulse would a RT palpate on a patient during a code? Carotid
Diminished breath sounds can be heard in which of the following disease process? COPD, Pleural effusion,Guillian-Barre, or CHF COPD, Pleural effusion and Guillian-Barre
What is another name for Acute Alveolar Hyperventilation Respiratory Alkalosis
Another name for Acute Ventilatory Failure Respiratory acidosis
4 respiratory diseases associated with chronic ventilatory failure Chronic bronchitis, emphysema, bronchiectasis, cystic fibrosis
Common causes of metabolic acidosis lactic acidosis (exercise)ketoacidosis (diabetes)renal failuredehydrationchronic diarrhea
Common causes of metabolic alkalosis Hypokalemiahypochloremiagastric suctioningvomitinguse of steroid medexcess sodium bicarb
What is a hazard of oxygen therapy in a patient wih chronic ventilatory failure suppress their hypoxic drive
During acute alveolar hypoventilation, the blood what happens to the blood? pH decreases, paCO2 increases, HCO3 remains the same
Metabolic alkalosis can develop from which of the following: hypercholremia, hypokalemia, hypocloremia or hyperkalemia? Hypokalemia and Hypochloremia
What ABG values would decrease in a diabetic ketoacidosis patient? pH, PaCO2, and HCO3
On an X-ray, consolidation or opacity is caused by _______ Pneumonia
On an x-ray, honeycombing is caused by ____ Pulmonary Fibrosis
On an x-ray, Infiltrates are caused by ____ ARDS
on an x-ray, the term dense means ___ white, as in fluid or tumors
On an x-ray, the term opaque means ____ White
on an x-ray, the term translucent means ___ dark areas
Define Bronchiectasis A change in airway, can occur alone or with other diseases, frequently found in lower lobes
What happens to secretions in the airways they get stuck in pockets which lead to infections, airways are cut off by secretion build-up
Describe secretions in bronchiectasis Copious amounts of foul smelling secretions
Bronchiectasis can lead to… Hyperinflation of the distal alveoli, Atelectasis (due to mucus plug), consolidation (airless or gassless due to fluid in aleoli), and parenchymal fibrosis
What are the 3 forms of bronchiectasis? Varicose (fusiform), cylindrical (tubular) and saccular (cystic, which cause the greatest damage)
An x-ray of bronchiectasis would show… Translucent (dark), depressed diaphragms, long and narrow heart, enlarged heart
what is the hallmark of bronchiectasis chronic cough and copious foul smelling secretions
Bronchiectasis culture of sputum will show sputum may separate into layers and will show h-influenza, strep, pseudomonas
a congenital cause of 50% of all bronchiectasis Cystic Fibrosis
CF is caused by mutation on chromosome 7
Genetic mutation of chromosome 7 causes abnormal electrolyte and H2O movement, Increased secretions
How do you diagnose CF Sweat test
Question Answer
What are the 2 types of asthma Extrinsic asthma-allergic Intrinsic asthma-non allergic
What is asthma A lung disorder characterized by Reversible bronchial smooth muscle constriction,Airway inflammation,Increased airway hyper-responsiveness to various stimuli
Status Asthmaticus does not respond to traditional treatment
After puberty asthma is more common in girls
What are the triggers of Asthma? Infection, exercise, dust, pollens, cold air, air pollution, cigarette smoke, emotional stress
what are the anatomic alterations of the lungs Smooth muscle constriction of bronchial airways (bronchospasm),Excessive production of thick, whitish,bronchial secretions,Mucus plugging,Hyperinflation of alveoli (air-trapping).In severe cases, atelectasis caused by mucus plugging
Extrinsic asthma caused by external or environmental agents Aka Allergic or Atopic Asthma
Intrinsic asthma occurs in the absence of antigen-antibody reaction.
Indoor allergens house dust, furred animal dander,cockroach, fungi, molds, yeast, mites
Outdoor alergens Pollen, molds,fungi, yeast
Hypersensitiviy reaction Excessive amounts of immunoglobulin E(IgE)production in response to antigens
Asthma that is family related (genetic predisposition) Extrinsic Asthma
Exposure to certain antigens antibodies formed, attach surface of mast cells in bronchial walls
Repeated exposure to antigens antigen-antibody reaction degranulation of mast cell release chemial mediators
Chemical mediators histamine, leukotrines, prostagladins neutrophil chemotactic factors NCF eosionphil chemotactic
Stimulates parasympathetic nerve cells in the airway bronchoconstriction, mucous hypersection,dilation of blood vessels,tissue edema
Occupational Asthma triggered by exposure to agent in work environment immunologically mediated
High risk work environments for occupational asthma farming and agriculture painting cleaning work plastic manufacturing
Asthmatic episode that cannot be directly linked to a specific antigen or extrinsic factor,not hypersensitive, Normal IgE levels, Onset usually after age 40 Intrinsic asthma
Other risk factors of Intrinsic Asthma obesity, sex(male is a sex risk factor for asthma in children), infections, exercise induced asthma,outdoor/indoor pollution, drugs, food additives, food preservatives, gastroesophageal reflux, sleep, emotional stress, perimenstrual asthma
Early response to allergic exposure seen within minutes of exposure to antigen;resolves in 1hr
Late response to allergic exposure begins several hours after exposure, but last much longer
Biphasic response to allergic exposure early response followed by late response
Diagnostic/Monitoring tests for asthma spirometry, Peak expiratory flow,Responsiveness to methacholine, histamine, mannitol, or exercise challenge Positive skin tests with allergens or measurement of specific IgE in serum
Classifications of asthma severity intermittent, mild persistent, moderate persistent, severe persistent
Intermittent Symptoms less than once a week Brief exacerbations Nocturnal symptoms not more than twice a month FEV1 or PEF > 80% predicted PEF or FEV1 variability < 20%
Mild Persistent Symptoms more than once a week but less than once a day Exacerbations may affect activity and sleep Nocturnal symptoms more than twice a month FEV1 or PEF > 80% predicted PEF or FEV1 variability < 20 – 30%
Moderate Persistent Symptoms daily Exacerbations may affect activity and sleep Nocturnal symptoms more than once a week Daily use of inhaled short-acting β2-agnonist FEV1 or PEF 60 – 80% predicted PEF or FEV1 variability > 30%
Severe Persistent Symptoms daily Frequent nocturnal asthma symptoms Limitation of physical activities FEV1 or PEF < 60% predicted PEF or FEV1 variability > 30%
Vital signs for asthmatic increased RR(tachypnea), HR(tachycardia), BP(hypertension)
Subjective inspection dyspnea and chest tightness
Objective inspection Use of accessory muscles I:E ratio > 1:3 Cyanosis Cough and sputum production During exacerbation, may have excessvie amount of thick, tenacious, white mucus Large number of eosinophils and other WBCs
Physical assessment of asthmatic Pulses paradoxus,Hyperresonance to percussion Wheezing Decreased, absent breath sounds Decreased heart sounds
Decreased blood pressure during inspiration Pulses paradoxus
Chest xray Not recommended for routine evaluation Often normal or may demonstrate hyperinflation Should be obtained in pts suspected of a complicating cardiopulmonary process, i.e. pneumonia
Term Definition
signs for cardiopulmonary distress are subjective, patient description EX) pain, shortness of breath, cough
symptoms for cardiopulmonary distress are objective, measurable, and assessed values EX) vital signs
assess symptoms to determine .. seriousness of problem, potential underlying cause, effectiveness of treatment
what are the 5 primary symptoms of cardiopulmonary disorders -cough -sputum production -hemoptysis -dyspnea -chest pain
what is the protective reflex our bodies use cough
what causes the cough inflammatory, mechanical, chemical, or thermal stimulation of receptors
what are our cough receptors pharynx, larynx, trachea, large bronchi, lung, and visceral pleura
key to determine etiology careful history, physical exam, and CXR
possible causes of inflammation infection, lung absceses, drug reaction, allergy, edema, hyperemia, tuberculosis
mechanical stimulation inhaled dust, suction catheter, food
obstruction stimulation tumors, foreign bodies
chemical stimulation inhaled irritant, gases, fumes, smoke
temperature stimulants inhaled hot or cold air
ear stimulants pressure in the middle ear
what is atelectasis collapsed alveoli
what is fibrosis damage to the lung areas/ scar tissue
nerves included in the Afferent pathway vagus, phrenic, glossopharyngeal, and trigeminal
nerves included in the Efferent pathway smooth muscles of larynx & tracheobronchial tree via phrenic, spinal
what reduces the effectiveness of a cough stroke, obstruction, emphysema, thick sputum
what does acute mean sudden onset, severe, viral infection(self-limiting)
what does chronic mean persistent, lasts over 3 weeks,
paroxysmal periodic, prolonged, forceful episodes
associated symptoms of coughing -wheezing -stridor -chest pain -dyspnea
what is stridor high pitched, musical breathing. (inspiratory)
complications of cough torn chest muscle, rib fractures, disruption of surgical wounds, arrhythmia, urinary incontinence
what is sputum secrections from tracheobronchial tree, pharynx, mouth, sinuses, nose
phlegm secretions from lungs
components of sputum mucus, cellular debris, microorganisms, blood, pus, foreign objects
normal sputum production 100ml/day
aspects of abnormal sputum color, quantity, consistency, odor, time of day, presence of blood
hemoptysis sputum containing blood
causes of hemoptysis cardiovascular, hematologic, systemic disorders, TB, bronchiopulmonary
hematemesis vomited blood, swallowed from resp tract
causes of hematemesis alcoholism or cirrhosis of the liver
blood PH of hemoptysis alkaline
blood PH OF hematemesis acidic
SOB shortness of breath, cardinal symptom of cardiac disease
dyspnea breathing discomfort ; breathless, short-winded
scoring system for dyspnea 0-10 (10 max SOB), Questionnaire, borg scale
types of dyspnea cardiac and circulatory, psychogenic, hyperventilation
cardiac dyspnea inadequate supply of o2 to tissues; prim during exercise
psychogenic dyspnea panic disorder, not related to exertion
hyperventilation dyspnea results on hypocapnia and decreased cerebral blood flow; resp rate exceeds body’s metabolic need
chronic dyspnea COPD, CHF
acute dyspnea asthma, bronchitis croup; in children, hyperventilation, panic disorder, pneumonia; in adults
paroxysmal nocturnal dyspnea when sleeping in recumbent position ; ass. with coughing; sign of left heart failure
orthopnea when lying down; ass with left heart failure
trepopnea when lying on one side; unilateral lung disease, pleural effusion
platypnea dyspnea in upright position
orthodeoxia hypoxemia in upright position, relieved by returning to a recumbent position
causes of chest pain cardiac ischemia; inflam. disease of thorax, abdomen; trauma anxiety
syncope dizziness and fainting
causes of syncope thrombosis, embolism, atherosclerotic obstruction ; bouts of laughing, hypoxia
orthostatic hypotension sudden drop in blood pressure when you stand up ; dizziness, blurred vision, syncope
causes of orthostatic hypotension elderly, vasodilator use, dehydration
carotid sinus syncope slows pulse rate, decreases blood pressure
tussive syncope caused by strong coughing, seen most in men with COPD, obesity.
dependent edema soft tissue swelling from abnormal accumulation of fluid
bilateral peripheral edema mostly occurs in ankles and lower legs
cause of bilateral peripheral edema right or left heart failure, *right failure often caused by cor pulmonale
euthermia fever, chills, night sweats 97-99.5 F
hyperthermia, pyrexia fever; sustained, remittent, relapsing
causes of fever hot environment, dehydration, drugs, infection
lung disease, high altitude headache causes headache as a manifestation of cerebral hypoxia and hypercapnia
most common cause of snoring obesity
clinical presentation of snoring fatigue, daytime sleepiness
GERD gastroesophageal reflux
GERD heartburn and regurgitation
risk factors of GERD OBESITY, cigarette smoking, pregnancy