Question Answer
Obstructive diseases affect all of the following EXCEPT:airways, expiration, increased airway resistance, tidal volume tidal volume
obstructive pulmonary disease and restrictive pulmonary disease sometimes occur as a mixed impairment: true or false true
what is the primary problem in Obstructive diseases? increased airway resistance
what is the primary problem in restrictive diseases? reduced lung compliance, thoracic compliance or both
moderate Obstructive disease will give you an FEV1 result of 50-59% True or False false
The ERV can be normal or reduced in restrictive lung diseases; True or false true
Asthma is considered what kind of disease? obstructive
A patient with restrictive lung disease has a ________ of VC. reduction
symptoms of obstructive disease include the following: cough, phlegm production, SOB, all of the above all of the above
A COPD patient with an FEV1/FVC <70% and FEV1<30% or FEV<50% is at what stage of the disease: very severe(stage IV)
A patient with an RV less than 1.20L is said to have what kind of disease? restrictive
A 20 year old patient was referred to the PFT lab, his results were as follows: FRC 2.23L, RV 1.00L, VT 355mL; based on these findings we can conclude that this patient has what kind of a disease? restrictive
A patient with a TLC of 80% less than the predicted value is said to have; a restrictive disease
A 45 year old male with a decreased PEFR is said to have; an obstructive disease
The DLCO in Obstructive and restrictive diseases can be reduced or normal: true or false true
If your patient is having difficulty with his inspiration, you would suspect he has a: restrictive disease
obstructive disease affect patients flow rate: true or false true
Cystic Fibrosis is an example of an: obstructive disease
neuromuscular diseases can result in restrictive type pulmonary impairments because they mainly affect the function of what muscle? inspiratory muscles
PFTs provide the basis for classifying obstructive and restrictive diseases; true or false true

Question Answer
acute exacerbation of COPD state of worsening, often defined by the need to increase medication or to escalate care
airway hyperresponsiveness (AHR) state of airways that cause them to constrict abnormally in response to stress or insults
airway inflammation acute inflammation of the lungs contracted form the environment
airway obstruction state of abnormally slowed expiration, characterized most commonly by a decrease in FEV1
asthma respiratory disorder characterized by recurring episodes of paroxysmal dyspnea, wheezing on expiration/inspiration caused by constriction of bronchi, coughing, and viscous mucoid bronchial secretions
bronchiectasis abnormal condition of bronchial tree characterized by irreversible dilation and destruction of bronchial walls
bronchocilator substance, especially a drug that relaxes contraction of the smooth muscle of bronchioles to improve ventilation to lungs
bronchospasm abnormal contraction of smooth muscle of bronchi, resulting in acute narrowing and obstruction
chronic bronchitis acute or chronic inflammation of mucous membranes of tracheobronchial tree
cystic fibrosis autosomal recessive disease characterized by pancreatic insufficiency, abnormally thick secretions from exocrine glands, and increased concentration of sodium and chloride in sweat glands
emphysema destructive process of lung parenchyma leading to permanent enlargement of distal air spaces, classified as either centrilobular or panlobular
noninvasive ventilation mechanical ventilation performed without intubation or tracheostomy, usually with mask ventilation
supplemental oxygen oxygen delivered at concentration exceeding 21% to increase amount circulating into blood

Question Answer
__________ _________ are the leading causes of admission to the neonatal intensive care unit. respiratory disorders
what is the axiom that is essential to the understanding of respiratory distress of the neonate? “oxygen is the primary nutrient of the human body”
what are the clinical manifestations presented by a baby in EARLY respiratory distress? lethargy, cyanosis, tachypnea, nasal flaring, expiratory grunting, intercostal/substernal retractions, tachycardia, hypertension, acute alveolar hyperventilation w/ hypoxemia
what are the clinical manifestations presented by a baby in LATE respiratory distress? bradypnea, gasping respirations, apnea, bradycardia, hypotension, acute ventilatory failure w/ both CO2 retention and hypoxemia
the compliance of the infant’s thorax is ____; however, the respiratory disorders make compliance io the lungs ____. high; low
what must the infant do in an effort to offset the decreased lung compliance? generate more negative intrapleural pressures during inspiration
what does this condition cause? 1. retraction of soft tissues b/t ribs 2. substernal retractions/protruding abdominal area during inspiration (seesaw) 3. cyanosis in thoracic/abdominal areas
what is the cause behind nasal flaring during respiratory distress? facial reflex to facilitate the movement of gas in the TBT
what is the muscle responsible for this movement? dilator naris (originates from maxilla, inserts into ala of the nose)
what is the mechanism behind nasal flaring? dilator naris pulls alae laterally and wides the nasal aperture (more room for gas)
what does expiratory grunting do to help the infant during RDS? generates high positive pressure in the alveoli which counteracts the hypoventilation
how does an expiratory grunt occur? epiglottis abruptly opens, gas rushes past vocal cords and produces grunt or cry
what is apnea of prematurity described as? cycles of short pauses in respiration followed by an increased breathing rate
what is apnea of prematurity defined as? cessation of breathing effort >20 secs in baby <37 wks (causes bradycardia, cyanosis, or both)
about ___% of premature babies weighing less than ____ g experience severe apnea. more than ___% of infants weighing more than ____ g manifest severe apnea. 75, 1250; 25, 1500
why are premature infants believed to be susceptible to apneic episodes? immature functioning of chemoreceptors, receptors in airways, and CNS
what else is thought to play an important role in causing sleep apnea? rapid eye movement sleep
what are the control of ventilation factors that trigger the apnea? REM sleep, decreased hypoxic/hypercapnic response, ondine’s curse (idiopathic alveolar hypoventilation)
what are the reflex stimulation conditions that trigger apnea? suctioning of nasopharynx/trachea, laryngeal stimulation, bowel movements, hiccups
what are the environmental conditions and neurologic disorders that trigger apnea? ambient temp changes; seizures, intracranial hemorrhage, meningitis
what are the drug depression and respiratory diseases that trigger apnea? sedatives, analgesics, prostaglandins; RDS, pneumona, TTN, MAS, BPD, DH
what are the cardiac disorders and systemic processes that trigger apnea? patent DA, CHF, R-L intracardiac shunt; hypothermia, hypoglycemia, hyponatremia, hypocalcemia, sepsis
what is the body position and anatomic abnormalities that trigger apnea? head flexion; micrognathia, choanal atresia, macroglossia
when is persistant pulmonary hypertension commonly seen in infants? w/ underlying resp disorder such as pneumonia, MAS, or RDS
what is PPHN caused in part by? reflex pulmonary vasoconstriction, activated by myriad stimuli (alv hypoxia, hypercapnia, dec pH)
after birth, approximately ___% of the PVR normally decreases within the first 24 hours in response to what? 80; increased PaO2/pH, lung expansion, release of vasoactive substances
why does the PVR stay high in infants with PPHN? what might appear b/c of the high PVR? pulmonary vascular hyperreactivity to irritating stimuli; cardiomegaly
when does PPHN usually appear and with what? first 12 hours of life; cyanosis, tachypnea, intercostal retractions, nasal flare, grunt
what do the ABGs show? shunt physiology (low PaO2 that is refractory to O2)
what are the maternal factors and cardiovascular factors associated with PPHN? diabetes, C-section, hypoxia; systemic hypotension, congenital heart disease, shock
what are the hematologic factors associated with PPHN? increased hematocrit, septicemia, maternal-fetal blood loss, acute blood loss
what are the respiratory diseases and fetal factors associated with PPHN? MAS, RDS, pneumonia; intrauterine stress, hypoxia, dec pH, placental vascular abnormalities
what are the other factors associated with PPHN? CNS disorders, hypoglycemia, hypocalcemia, neuromuscular disorders
what ABGs are commonly seen in newborn babies with pulmonary disorders? acute alveolar hyperventilation w/ hypoxemia and acute ventilatory failure
what are the 3 major mechanisms responsible for the decreased PaO2 observed in the disorders of the newborn? 1. pulmonary shunting and venous admixture 2. PPHN 3. infant fatigue
what is the apgar score? rating system for the rapid identification of infants requireing immediate intervention or NICU
when is the apgar evaluation performed? 1 minute after birth and again 5 minutes later
what are the 5 factors that are evaluated from a score of 0-2? heart rate, respiratory effort, muscle tone, reflex irritability, color
what does the scoring system represent? 0-3: severe distress, 4-6: moderate distress, 7-10: absence of difficulty in adjusting
what does a low 1-minute score require? what is required for a remaining low score at 5 minutes? immediate intervention, O2, oral/nasal suctioning; NICU, CPAP, umbilical cath, MV
what is MAS? clinical entity seen primarily in full-term or postterm infants w/ hypoxemia prenatally or during birth
what is meconium? material that collects in the intestine of fetus and forms first stools of newborn; odorless, thick, sticky, blackish green
what are the 3 complications of MAS? upper airway obstruction at birth, chemical pneumonitis, pulmonary arterial vasoconstriction and vasospasm (pulm HTN)
airways that are partially obstructed by meconium are affected by what? and what is this? “ball-valve” effect; air can enter but cannot readily leave the distal airways and alveoli
in mild conditions meconium can be found where? in severe conditions meconium can be found where at birth? smaller airways; distal airways
what can this condition lead to? then leads to what? air trapping and alveolar hyperinflation; alveolar rupture and air leak syndromes
what do totally obstructed airways lead to and cause? alveolar shrinkage and atelectasis; increased FRC and decrease in air flow during exhalation
what is chemical pneumonitis? what does it commonly lead too? acute inflammatory reaction & edema of bronchial mucosa and alveolar epithelium; excessive bronchial secretions/alveolar consolidation
when does RDS complicate MAS? when it interferes with alveolar pulmonary surfactant production
what are 3 major pathologic or structural changes associated with MAS? 1. excessive bronchial secretions 2. alveolar consolidation 3. pulmonary HTN
how many infants are diagnosed with MAS annually? what is the overall mortality rate? 10,000-15,000; 4%
what does fetal hypoxemia cause? vagal response that relaxes anal sphincter tone and allows meconium into amniotic fluid
MAS is rarely seen in infants younger than ___ weeks. ___ weeks gestation postterm infants are especially at risk of MAS. 36; 42
what other infants are at risk of MAS? small for gestational age, breech position, mothers are toxemic, hypertensive, obese
what are the vital signs for MAS? what are te other data obtained at bedside? tachypnea, tachycardia, HTN, apnea; expiratory grunting, cyanosis
what are the chest assessment findings? wheezes, rhonchi, crackles
what is the common general appearance for MAS? meconium staining on skin, nails, umbilical cord, wrinkles and creases in skin; barrel chest
what is the mild-moderate ABG? severe ABG? acute alveolar hyperventilation w/ hypoxemia; acute ventilatory failure w/ hypoxemia
what is shown on CXR if alveolar atelectasis and consolidation is present? what if partial airway obstruction, air trapping, and alveolar hyperinflation are present? irregular densities; hyperlucent and diaphragm depressed
what is MAS difficult to differentiate from on a CXR? pneumonia
what should be done if the infant is not actively breathing or crying immediately after delivery? intubation and suction upper airways
what should NOT be administered until a thorough suctioning of the upper airway has been completed? positive-pressure ventilation
what should be done after infant is stabilized in NICU? vigourous bronchial hygiene; O2 therapy, and MV in severe cases
_________ are given for chemical pneumonitis. antibiotics
meconium-stained amniotic fluid is seen in approximately ___% of all births. 10
within __-__ hours after birth, TTN produces clinical signs very similar to those associated with the early stages of ____. 4-6; RDS
what does the infant with TTN have? delay in pulmonary fluid absorption by lymphatic system and pulmonary capillaries
when do the anatomic alterations of the lungs associated with TTN begin to resolve? 48-72 hours after birth
what are 3 major pathologic or structural changes associated with TTN? 1. air trapping/alveolar hyperinflation 2. pulm capillary congestion 3. interstitial edema
TTN affects __-__% of all newborns and most often seen in ________ infants. 1-2%; full-term
what are the risk factors for TTN? elective C-section, excessive fluids to mother during labor, males, macrosomia
what might the infants history include with TTN? maternal analgesia or anesthesia during labor/delivery or intrauterine hypoxia
what is TTN also commonly associated with? maternal bleeding, maternal diabetes, prolapsed cord; very small infants
what is it believed that TTN results from? delayed absorption of fetal lung fluid
how are infants with TTN at birth? lethargic, results in depressed cough effort and accumulation of airway secretions and mucus
what develops after the first few hours and what are the early clinical manifestations? RDS; tachypnea (80-120), retractions, nasal flaring, grunting, cyanosis
what is the hallmark clinical manifestation of TTN? rapid and shallow breathing
what are the clinical signs of TTN? tachypnea, tachycardia, HTN, intercostal retractions, expiratory grunting, cyanosis
what are the chest assessment findings? wheezes, rhonchi, crackles
what is the mild-moderate ABG? severe ABG? acute alveolar hyperventilation w/ hypoxemia; acute ventilatory failure w/ hypoxemia
what does the CXR appear initially? and what are the signs over the next 4-6 hours? normal; perihilar streaking, air bronchograms, fluid in interlobular fissures
what are associated on CXR with air trapping and hyperinflation? peripheral hyperlucency, flattened diaphragms, bulging intercostal spaces; patches of infiltrates
what does the treatment of TTN consist mostly of? proper stabilization, close monitoring, and frequent and thorough evaluation
what are the resp. care treatment protocols? O2 therapy, bronchopulmonary hygiene, lung expansion therapy, MV (rare)
what is the most common cause of respiratory failure in the preterm infant? RDS
what does respiratory distress characterize? an immature lung disorder in a preterm infant caused by in
what is RDS a major cause of? morbidity and mortality in the premature infant born after <37 weeks’ gestation
what has greatly improved the clinical course and reduced the morbidity and mortality rates? introduction of exogenous surfactant therapy
what are the lungs like in RDS? dark red and liver-like
what type of lung disorder is RDS? restrictive
what happens if pulmonary hypoperfusion (worsens hypoxemia) does not resolve within 24 hours? shunting will begin to flow from left to right through the patent ductus arteriosus
what are 3 major pathologic or structural changes associated with RDS? 1.alveolar consolidation 2. intraalveolar hyaline membrane 3. atelectasis
what are the 2 reasons it is believed that the early stages of RDS develop from? 1. pulm.surfactant abnormality or deficiency 2. pulm. hypoperfusion evoked by hypoxia
what is the 7 steps to the development to RDS? 1. alveolar collapse 2. incr WOB 3. decr PAO2 4. pulm vasoconstriction 5. lung hypoperfusion 6. lung ischemia, decr lung metabolism 7. pulm surfactant decr even more
how many cases of RDS occur annually in the YS? and what is it the leading cause of? 30,000; death in preterm infants
about ___% of the neonates born at ___ to ___ weeks’ gestation develop RDS. about ___% of the babies born at ___ to ___ weeks’ gestation develop RDS. 50; 26, 28; 25; 30, 31
RDS occurs more often in _____ babies and is usually more severe than in ______ babies. why is this? male; female; increased circulating androgens in males (slows maturity of lungs)
what does the delayed lung maturation result in? immature alveolar type II cells (granular pneumocytes) and a decr pulm surfactant production
when is RDS also commonly seen? diabetic mothers, white preterm babies compared w/ black, C-section babies
what is RDS also associated with? low birth weight (1000-1500 g), multiple births, prenatal asphyxia, prolonged labor, maternal bleeding, second-born twins
what are the 3 primary tests to determine lung maturity? 1. L/S ratio 2. presence of phosphatidylglycerol (PG) 3. surfactant/albumin ratio
when is an L:S ratio normal and when is it likely RDS will develop? 2:1; 1:1
Lethicin is the _____ most abundant phospholipid in surfactant, PG is the ______. first; second
when is their a chance for RDS without PG? L:S ratio of <2:1 and a lack of PG
when does an S:A ratio indicate immature lungs, uncertain lung maturity, and adequate lung maturity? <35; 35-55; >55
what are the clinical findings for RDS? tachypnea, tachycardia, hypertension, apnea, expiratory grunting, cyanosis
what is the respiratory pattern for RDS? “hard, fast, and deep breathing”
what are the chest assessment findings? bronchial (or harsh) breath sounds, fine crackles
what is the mild-moderate ABG? severe ABG? acute alveolar hyperventilation w/ hypoxemia; acute ventilatory failure w/ hypoxemia
what is found on the CXR? increased opacity (ground-glass appearance) – more severe RDS, whiter the x-ray image
what is the treatment of choice for RDS? CPAP
why does CPAP work well with these patients? 1. increases FRC 2. decreases WOB 3. works to increase the PaO2
what is the normal PaO2 for newborn infants? 40-70 mmHg
what should be specially be watched with an infant with RDS? thermal environment
what are the 3 exogenous surfactant preparations commonly administered? beractant (survanta), calfactant (infasurf), poractant alfa (curosurf)
what are the resp care treatment protocols? O2 therapy, lung expansion therapy, MV (prolonged as long as possible)

Question Answer
The major pathologic or structural changes associated with emphysema are: Permanent enlargement and destruction of respiratory bronchioles,Destruction of pulmonary capillaries,Hyperinflation of alveolii
Panlobular emphysema is the abnormal dilation of the airways: Distal to the terminal bronchioles
Important etiologic factors of emphysema are: Cigarette smoking,Gastroesophageal reflex disease,Alpha-1 antitrypsin deficiency
Polycythemia and corpulmonale associated with severe emphysema may lead to the following: Distended neck veins,Pitting edema,Enlarged and tender liver
Emphysema accompanied by chronic bronchitis may lead to: Polycythemia
Chest radiographic findings on a patient with emphysema may include: Depressed or flattened diaphragms,Enlarged heart,Increased retrosternal air spaces
Functional Residual capacity (FRC) is higher in a patient with severe emphysema because: Increased RV due to air-traping
Sputum examination of an emphysematic patient (when accompanied by chronic bronchitis) most commonly: Streptococus pneumoniae,Haemophilus Influenza
The combination of air trapping, lung hyperinflation, and alveolar hypoventilation associated with emphysema leads to an increased v/q ratio. t or f? False
Which is the most appropriate lung volume for a patient with emphysema? Increased tidal volume
Percussion notes on a patient with emphysema are hyperresonant.
Which of the following pulmonary function study findings are associated with severe emphysema? Increased FRC, Increased RV, Decreased FVC
Which of the folllowing is true regarding a patient in severe emphysema? Fully compensated respiratory acidosis with hypoxemia
The lung parenchyma in the chest radiograph of a patient with emphysema appear More translucent than normal,Dark
Major anatomic alterations of the lungs associated with emphysema: Distal airway and alveolar weakening,Alveolar hyperinflation (air-trapping),Permanent enlargement and deterioration of alveoli
Chest assessment findings of a patient with chronic bronchitis: Hyperresonant percussion note, Diminished breath sound, Rhonchi or crackles
Which of the following is most commonly seen on sputum examination in a patient with chronic bronchitis? Streptococus pneumoniae
In the treatment of patients presenting to the hospital with moderate or severe acute exacerbation of COPD, the following therapeutic options are benefitial: Systemic corticosteroids up to 2 weeks, if not on long term steroid therapy, Noninvasive positive pressure ventilation,Oxygen, with caution, in hypoxemic patients
In chronic bronchitis,The bronchial glands are enlarged
Which of the following is/are believed to play a major etiologic role in chronic bronchitis? Ozone,Sulpher dioxide,Nitrogen oxide.
Spirometry results on a patient with chronic bronchitis shows which of the following? ERV? decreased
Patients with severe chronic bronchitis may demonstrate which of the following? Distended neck vein,An elevated hemoglobin concentration, An enlarged liver
In the treatment of patients presenting to the hospital with moderate or severe acute exacerbration of COPD, the following therapeutic options are beneficial: Systemic corticosteroids (up to 2 weeks) if the patient is not receiving long term oral steroid
Chronic bronchitis is charecterised by: Bronchial smooth muscle constriction,Anatomic changes in smaller airways, Alveolar hyperinflation
Which of the following is/are true regarding intrinsic asthma? Asthmatic episode cannot be linked to a specific antigen, Normal serum IgE level when exposed to antigen,Also called nonatopic asthma
The immunologic response in asthma releases the following chemical mediators: Histamine,Leukotrines,ECF-A
With regard to the Asthma Zone Management System, the “Yellow Zone” is defined as: 50-80% of personal best PEFR
Step 4, in the Stepwise Approach for the Management of Asthma in Adults and Children (National Institutes of Health), is described as: Severe persistent
When pulsus paradoxus appears during an asthmatic attack: Systolic blood pressure is more than 10 mm Hg lower on inspiration than expiration
Which of the following doesn’t affect Oxygen transport (D02): Tidal volume
Asthma is associated with Atelectasis (severe cases)
What condition which is not applicable with asthma Chronic dilation of bronchial airway
When chemical mediators from mast cells are released: Bronchial gland hypersecretion occurs,Tissue edema occurs
During an asthmatic episode, which of the following spirometry values are true? Decreased PEFR,Decreased FVC
During mast cell degranulation, which of the following chemical mediators are released? ECF-A,Histamine,Leukotrines
Patients commonly exhibit which of the following arterial blood gas values during an acute asthmatic episode. Increased pH,Decreased Bicarbonate,Decreased PaO2
Recommended treatment regimen for asthmatic when peak flow meter shows 55% of the personal best is: Temporary increase in medication
First line preventer (controller) agent for asthma is Cromolyn sodium
Major pathologic or structural changes associated with bronchiectasis: Excessive production of often foul-smelling sputum,Hyperinflation of the distal alveolii,telectasis, consolidation and fibrosis
Major forms of bronchiectasis are: Vericose,Saccular,Cylindrical
Which of the following is true regarding vericose(fusiform) bronchiectasis: Bronchi are dilated and constricted in irregular fashion.
Which type of bronchiectasis causes the greatest damage to the tracheobronchial tree? Sacular bronchiectasis
The etiology of bronchiectasis is not always clear.  
Which of the following are the causes of acquired bronchiectasis? Repeated and prologed respiratory tract infections,Bronchial obstruction caused by foreign bodies,Respiratory complications of chickemnpox
Commonly cultured organisms from the sputum of patients with bronchiectasis are: Haemophilus Influenzae,Streptococus,Pseudomonas aeruginosa
Arterial blood gas in a severe bronchiectasis is most likely: Chronic ventilatory failure with hypoxemia
Bronchiectasis is primarily: Restrictive or obstructive disease
Which of the following are common causes of acquired bronchiectasis? . Pulmonary tuberculosis
In the primary obstructive form of bronchiectasis, the patient commonly demonstrates which of the following? Decreased PEFR
Which of the following are classified as Mucolytic agents to enhance the mobilization of secretions? Acetylcysteine,rhDNase
When the pathophysiology of bronchiectasis is primarily obstructive in nature the patient demonstrates which of the following clinical manifestations? Decreased tactile and voclal fremitus,Crackles/rhonchi/wheezing
Which of the following diagnostic procedures is/are used to diagnose bronchiectasis? Bronchography,Computed tomography
Which of the following is/are congenital causes of bronchiectasis? Cystic Fibrosis
Haemophilus influenzae Gram-negative organism
Streptococcus Gram-positive organism
Enterobacter species Gram-negative organism
Respiratory syncytial virus (RSV) Viral cause
Pseudomonas aeruginosa Gram-negative organism
Mycoplasma pneumonia Atypical organism
Staphylococcus Gram-positive organism
Severe acute respiratory syndrome (SARS) Viral cause
Most bacterial pneumonias are caused by Streptococcus bacteria. t or f? t
Increased respiratory rate, increased heart rate , and decreased chest expansion are usually noticed on patients with pneumonia during physical assessment. t or f? t
The coronavirus is associated with SARS. t or f? t
Patients with pneumonia usually produce soft, diminished breath sounds over the affected area. t or f? f
In pneumonia, percussion notes are usually dull over the affected area. t or f? t
Which of the following is/are commonly seen in patients with AIDS? Aspergillus,Cryptococus, Pneumocysis carinii,Cytomegalovirus
The first drug of choice in treating a lung abscess is: Penicillin
The chest assessment findings commonly show which of the following directly over the abscess? Crackles and rhonchi,Dull percussion note,Bronchial breath sounds,Diminished breath sounds
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
Which of the following anatomic alterations of the lungs is/are associated with lung abscess? Alveolar consolidation,Bronchopleural fistulae,Atelectasis,Excessive airway secretions
Anatomically, a lung abscess most commonly forms in which part(s) of the lung: Posterior segment of the upper lung,Superior segment of the lower lobe.
Which of the following pulmonary function findings may be associated with severe and extensive lung abcess? Decreased FVC,Decreased RV
Mycobacterium tuberculosis organisms enters humans in the following ways Respiratory tract,Gastrointestinal tract,Open wound in the skin
A positive tuberculin test begins with a wheal of what size? 10 mm or greater
TB infection that escapes from a tubercle and rapidly disseminate to sites other than the lungs by means of: Blood stream
The most common oxygen rich areas where the disseminated TB bacilli resides are: Regional lymph nodes,Kidneys,Ends of long bones
What is the name of the protective cell wall that surrounds and encases lung tissue infected with tuberculosis? Granuloma,Tubercle
Drug resistant TB is probable if the person infected with TB Is foreign born,Had previous antituberculous drug therapy,Been exposed to another patient with drug resistant TB
Positive reaction confirms that a patient has active TB
Coccidioidomycosis is also known as: Desert fever,San Joaquin Valley disease,Valley fever
Which of the following is considered the drug of choice for severe fungal diseases of the lungs? Amphotercin B
Fungal diseases most commonly involve the apical and posterior segments of the upper lung lobes. t or f? t
Fungal diseases and tuberculosis cause similar anatomic changes of the lungs. t or f? t
When fungal spores are inhaled, which of the following pathologic or structural changes of the lungs may happen? Alveolar consolidation,Fibrosis and secondary calcification of the lungs,Caseous tubercles or granulomas
Signs and symptoms of chronic pulmonary histoplasmosis is charecterized by infiltration and cavity formation in the upper lobes of one or both lungs. What are the signs and symptoms of the disease at this stage? Fever,Weight loss,Hemoptysis
The diagnosis of blastomycosis can be made by: Fungal stain test,Culture of the fungus
The condition called desert bumps, desert arthritis, or desert rheumatism is associated with which of the following disorder? Coccidomycosis
Opportunistic infection is: An infection caused primarily by a non-pathogenic organism in an immunocompromised individual.
Which of the following statements are TRUE regarding restrictive lung disorders and obstructive lung diseases. Lung volumes are lower in restrictive lung disorders,Expiratory flow rates are lower in obstructive lung disorders
During acute pulmonary edema: Alveolar surface tension increases
Colloid osmotic pressure is also called colloid oncotic pressure
Which one on the pulmonary function values during pulmonary edema is correct?VT is normal or decreased
in pulmonary edema, an increased hydrostatic pressure is caused by: Excessive sodium consumption
The normal colloid osmotic pressure in the pulmonary capillaries: 25-30 mm Hg
Paroxysmal nocturnal dyspnea is: Inability to breath in a supine position
Which of the following is/are considered noncardiogenic cause(s) of increased capillary permeability? Head injury,Pneumonia,Sulfur dioxide,Alveolar hypoxia
What is the normal hydrostatic pressure in the pulmonary capillaries? 10-15 mm Hg
In pulmonary edema, fluid first moves into the: Perivascular interstitial space,Peribronchial interstitial space
Which of the following are causes of cardiogenic pulmonary edema? Excessive fluid administration,
When a patient with pulmonary edema lies down, pulmonary hydrostatic pressure rises. This action will: Promotes pulmonary shunting,Raises venus admixture,Causes hypoxemia
Mask CPAP has been shown to produce significant and rapid improvement in oxygentation and ventilatory status in patients with pulmonary edema due to: Decreases vascular congestion,Enhances gas exchange.
Acute pulmonary edema is treated by: Oxygen,Morphin sulphate,Lasix
A large embolus that lodges in the bifurcation of the pulmonary artery is called a Saddle embolus
When an embolus lodges in the pulmonary vascular system, the ventilation beyond the obstruction results: Wasted ventilation
As a result of the decreased systemic blood pressure associated with a pulmonary embolism, reflexes from the aortic and carotid sinus baroreceptors cause: Increased heart rate and ventilatory rate
The last resort in treating pulmonary embolism because of the mortality rate associated with it is: Pulmonary embolectomy
The loss of consciousness resulting from insufficient blood flow to the brain is called: Syncope
If ABG shows acute ventilatory failure for a patient with severe pulmonary emboli, the most appropriate treatment is: Continuous mechanical ventilation
Which of the following is/are major mechanisms that contribute to the pulmonary hypertension commonly seen in the patients with pulmonary embolism? Decreased cross-section area of the pulmonary vascular system because of the emboli, Vasoconstriction induced by alveolar hypoxia, Vasconstriction induced by humoral agents
Which of the following thrombolytic agents is/are used to treat pulmonary embolism? Urokinase,Tissue plasminogen activator (TPA,Streptokinase
If the pulmonary embolism significantly disrupts blood flow pulmonary infarction develops and causes: Alveolar atelectasis,Consolidation,Bronchial smooth muscle constriction
A first-choice test for patients suspected of having pulmonary embolism is Fast Computed Tomography Scan
Chest radiograph findings of patients with pulmonary embolism: Dilation of the pulmonary arteries,Pulmonary edema,Right ventricular cardiomegaly
When humoral agents such as serotonin are released into the pulmonary circulation, which of the following occur? The V/Q ratio decreases,The bronchial smooth muscle constrict
Most pulmonary emboli originates from Leg and pelvic vein
As a consequence of severe flail chest, which of the following occurs? VT decreases,FRC decreases
When a patient has a severe flail chest, which of the following occurs? Cardiac output decreases,VO2 remains unchanged
A flail chest is the result of double fractures of: Three or more adjacent ribs
When a paradoxical movement is seen in a patient with a flail chest, the fractured ribs: Sink in during inspiration
In mild cases of flail chest the required treatment is: Pain medication,Routine bronchial hygiene
In severe cases of flail chest the management of patient include: Stabilization of chest wall,Volume caontrol ventilation with PEEP
Which of the following pathophysiologic mechanisms may be activated as a result of a flail chest and increase the patient’s respiratory rate? V/Q ratio decreases,Stimulation of the peripheral chemoreceptors
When gas enters the pleural space during inspiration but is unable to leave during expiration, the patient is said to have a/an: Valvular pneumothorax,Tension pneumothorax
Which of the following may cause a pneumothorax? Pneumonia,Tuberculosis,Bulla
When a patient has a pneumothorax because of a suckling chest wound, which of the following occurrs? The mediastinum often moves to the unaffected side during inspiration, Intrapleural pressure on the affected side often rises above the atmospheric pressure during inspiration,The mediastinum often moves to the affected side during expiration
A patient with a severe tension pneumothorax demonstrates which of the following? Diminished breath sound,Hyperresonant percussion note
Which of the following is not a major pathologic change associated with pneumothorax: Increase venus return
In an open pneumothorax: Pleural space is in direct contact with atmosphere,Gas can move in and out of pleural space,Also called sucking chest wound
A pneumothorax in which the intrapleural pressure exceeds intraalveolar pressure is called: Tension pneumothorax
When treating a pneumothorax with a chest tube and suction, the negative pressure used is: -5 cm H2O
When the pneumothorax is 15-20% the patient may need: Bed rest or limited physical activity
Bed rest or limited physical activity Needle aspiration
Which of the following is the common causes of transudative pleural effusion? CHF
Trauma to the neck commonly causes which of the following? Chylothorax
Which of the following is/are major causes of an exudative pleural effusion? Tuberculosis,Pneumonia,Fungal diseases
A pleural effusion commonly demonstrates which of the following findings during a chest assessment? Dull percussion note,Tracheal shift
Which of the following is/are associated with transudative pleural effusion? Thin and watery fluid,Few blood cells
Fluid samples from a thoracentesis may be examined for which of the following? Protein and glucose,Cytology,RBC count,AFB stains
Chylothorax Presence of the milky liquid (produced in the small intestine during digestion) in the pleural cavity
Empyema Pus in the pleural cavity
Pleurodesis A chemical or medication is injected in to the chest cavity
Thoracentesis Puncture of the chest wall for the removal of fluid
Which of the following pulmonary function value(s) is/are true in kyphoscoliosis? Decreased VT,Decreased RV
The clinical manifestations associated with kyphoscoliosis are Mucus accumulation throughout tracheobronchial tree,Atelectasis,Mediastinal shift
Which of the following is/are associated with kyphoscoliosis? Dull percussion note, Bronchial breath sounds
Kyphosis is a lateral curve of the spine.t or f? false
Polycythemia and cor pulmonale are associated with kyphoscoliosis. t or f? True
The following statements are true regarding kyphoscoliosis Surgery is recommended if the curvature of the spine is greater than 50 degrees, Braces does not cure scoliosis
The etiologic determinants in the development of pneumoconiosis include the following except: Size of the inhaled particles is between 0.5 and 1.2 microns is likely to reach the alveoli
The DLCO is normal in pneumoconiosis.t or f? f
A lower-than-normal hemoglobin concentration is associated with severe pneumoconiosis. t or f? f
The clinical manifestations associated with pneumoconiosis are based on the clinical scenarios activated by which of the following? Increased alveolar-capillary membrane thickness, Bronchospasm
Chest radiographic findings of patient with pneumoconiosis include Small rounded opacities scattered throughout the lung,Honeycomb appearance
Which of the following expiratory maneuver findings is/are associated with the pneumoconioses? Decreased FEV 1.0,Decreased FVC
The fibrotic changes that develop in coal worker’s pneumoconiosis usually result from which of the following? silica
growth rate of Small-cell carcinoma very fast
growth rate of Squamous cell carcinoma slow
growth rate of Adenocarcinoma moderate
Which of the following is associated with bronchogenic carcinoma? Alveolar consolidation,Pleural effusion,Atelectasis
Benign tumors: grow slowly.,are usually encapsulated.
Which of the following has the fastest growth (doubling) rate? Oat-cell carcinoma
Which of the following is/are non–small-cell lung cancer(s)? Undifferentiated carcinoma,Squamous carcinoma,Adenocarcinoma
Squamous cell carcinoma is strongly associated with cigarette smoking. t or f? t
Adenocarcinoma arises from the mucous glands of the tracheobronchial tree. t or f? t
Surgical resection is the principle form of treatment for patients with Stage I or Stage II lung cancer. t or f? t
Hypoxemia caused by capillary shunting often is refractory to oxygen therapy.t or f? t
Which of the following statements is true regarding ARDS? Bronchial breath sounds are associated with ARDS.
During early stages of ARDS, the patient commonly demonstrates which of the following arterial blood gas? decreased HcO3
ARDS has been called many different names in the medical literature. Primarily, the names have been based on the etiology believed to be responsible for the disease. t or f? t  
The clinical manifestations associated with ARDS are based on the clinical scenarios activated by which of the following? Consolidation, Increased alveolar-capillary membrane thickness,Atelectasis
What is the generic name of Lasix? Furosemide
Disseminated intravascular coagulation (DIC) seen in patients with shock is a condition of paradoxical simultaneous clotting and bleeding that produces microthrombi in the lungs. t or f? t
Which of the following is not true regarding ARDS? Hyperresonant percussion note
Ventilation strategy for most patients with ARDS is: Tidal volume is 4 to 8 ml/kg of ideal body weight
The patient with interstitial lung disease may demonstrate: Obstructive disorder, restrictive disorder, or a combination of obstructive and restritive disorder
Which of the following is another name for extrinsic allergic alveolitis? Hypersensitivity pneumonitis
Which of the following disorder is associated with desqumative interstitial pneumonia and usual interstitial pneumonia? Idiopathic pulmonary fibrosis
Pulmonary manifestations of Systemic Lupus Erythematosus are: Pleurisy with or without effusion,Atelectasis,Diffuse interstitial lung disease,Diaphramatic dysfunction,Infection
Which of the following pulmonary function study findings is/are associated with chronic interstitial lung disease? Normal or decreased FEV1,Decreased FVC
A pleural effusion is commonly associated with which of the following chronic interstitial lung diseases? systemic lupus erythematosus,Rhematoid arthritis
The diagnosis of drug induced interstitial lung disease is confirmed by: Open lung biopsy
The organs primarily involved in Goodpasture’s syndrome are: Lung,Kidney
Bronchiolitis Obliterans with Organizing Pneumonia (BOOP) has been associated with the following except: Anemia
The respiratory clinical manifestations associated with Guillain-Barré Syndrome are based on the clinical scenarios activated by which of the following? Consolidation, Excessive bronchial secretions, Atelectasis
Common noncardiopulmonary manifestations associated with Guillain-Barré is/are: decreased ability to swallow.,decreased gag reflex.,tingling sensation and numbness,sensory nerve impairment.
Although the precise cause of Guillain-Barre syndrome is not known, it’s probably: An immune disorder that causes inflammation and deterioration of peripheral nervous system.
Which of the following are possible precursors to Guillain-Barre syndrome? Mumps,Measles,Infectious mononucleosis
In Gullian Barre Sydrome, which of the following pathologic changes develop in the perepheral nerves? inflammation,Demyelination, Edema
The diagnosis of Guillain-Barre Syndrome is based on patient’s: Clinical history,Significant signs include paralysis,CSF findings
Which one of the following has been shown effective in severe cases of Guillain-Barre Syndrome: Plasmapheresis (plasma exchange)
Which of the following is/are common noncardiopulmonary manifestations associated with myasthenia gravis? Double vision,Weakness of arms and legs,Drooping of upper eyelids,Speech impairment
Which of the following is/are used to treat myasthenia gravis? Prostigmin (neostigmine,Thymectomy,Edrophonium chloride (tensilon)
Which of the following is/are associated with myasthenia gravis? Decreased FEV1, Decreased FVC
The cause of Myasthenia Gravis is due to the disruption of the chemical transmission of ACH at neuromuscular junction by; Blocking the ACH from the receptor sites of the muscular cell,Accelerating the breakdown of ACH
The diagnosis of Myasthenia Gravis is based on: Clinical history,Neurological examination,Blood analysis,Edrophonium (Tensilon) test
If the patient has Myasthenia Gravis, administration of Tensilon would increase the muscle strength for about: 10 minutes
Weakness of the muscles of the lower portion of the face is associated with myasthenia gravis.t or f? t
Because ventilatory failure is possible patients with Myasthenia Gravis is frequently monitored with the following measurements: Vital Capacity,Maximum Inspiratory Pressure (MIP),Arterial Blood Gasses (SpO2)
Rationale for thymectomy for young adult females with Myastenia Gravis is due to the belief that the thymus gland is the source of: Anti-ACH antibodies
Sleep apnea is diagnosed in patients who have: More than 5 episodes of apnea per hour over a 6-hour period
Non-REM sleep is also called active sleep. t or f? f
Negative-pressure ventilation is contraindicated in obstructive sleep apnea. t or f? True
During periods of sleep apnea, the patient commonly demonstrates an increased heart rate.t or f? True
The O2ER is decreased in sleep apnea. t or f? False
Which of the following cardiac arrhythmias is/are associated with severe sleep apnea? Atrioventricular block,Sinus bradycardia,Ventricular tachycardia,Premature ventricular contraction,Sinus arrhythmia
Which is another name for non-rapid eye movement? Slow wave sleep,Quiet sleep
Pickwickian syndrome is associated with which of the following? Obstructive sleep apnea,Obesity,Loud snoring
Some clinical disorders associated with obstructive sleep apnea are: Obesity,Enlarged tonsils or adenoids
Periods of severe sleep apnea are commonly associated with which of the following: Premature ventricular contraction,Ventricular tachycardia,Sinus bradycardia
Which of the following therapy modalities are therapeutic for central sleep apnea? Negative pressure ventilation
Which of the following is NOT monitored in Polysomnographic monitoring? Calorimeter to measure the calories used during sleep
Which of the following is true about near drowning? Victim survives a liquid submersion at least temporarily
Cardiopulmonary clinical manifestations associated with near drowning victim: ncreased respiratory rate,increased heart rate,crackles and ronchi , Fluffy infiltrates in chest X-ray
Radiogrphic deterioration in a near drowning patient may occur in the first: 48 to 72 hours
Which one of the folowing is not an indication for mechanical ventilation for a near drowning victim? Atelectasis
The indication for mechanical ventilation in a spontaneously breathing patient with smoke inhalation is: PaO2 of 60 mm Hg or greater with an FiO2 of 50% or lower
the hypothermia in a near drowning victim can be corrected by the following except:Continuous nebulized aerosol therapy  
Except for the rare instances of steam inhalation, direct thermal injuries usually do not occur below the level of which of the following? Larynx
Thermal injuries to the distal airways results in: Mucosal edema,Vascular congestion,Obliterative bronchiolitis
Organisms commonly cultured in the intermediate stage of burns include: Staphylococus,Pseudomonas,Klebsiella
During the late stage (5 or more days post smoke inhalation) infections resulting from burn wounds may lead to the following: Sepsis,Multiorgan failure, Pneumonia, Pulmonary Embolism
The prognosis of the fire victims usually is determined by: The extent and duration of smoke exposure,Size and depth of body surface burn,Pre-existing health status
When chest burns are present, the patient’s pulmonary condition may be further aggravated by which of the following? Decreased lung and chest compliance,Increased airway resistance,Immobility, Pain
Which of the following is/are the pulmonary related pathologic change(s) associated with smoke inhalation? pulmonary embolism,Pulmonary edema,Bronchospasm
Healing time for a seceond-degree burn is between: 7 and 21 days
Long term effects of smoke inhalation result in restrictive and obstructive lung disorders, a restrictive lung disorder develops from: Alveolar fibrosis
fluid resuscitation w/ ringer’s lactate solution is usually initiated according to the parkland formula, which is 4 ml/kg of body weight for each percent of BSA burned over a 24 hour period.

Question Answer
Define COPD Chronic Obstructive Pulmonary Disease is a preventable and treatable disease state characterized by airflow limitation that is not fully reversible.
Describe the clinical definition of Chronic Bronchitis Chronic Bronchitis is defines clinically as chronic productive cough for 3 months in each of 2 successive years in a patient in whom other causes of productive chronic cough have been excluded.
Identify the most important or primary cause of Chronic Bronchitis cigarette smoking
Chronic Bronchitis The conducting airways (particularly the bronchi)are the primary structures that undergo change in chronic bronchitis.
Clinical manifestations of Chronic Bronchitis Chronic inflammation and swelling of the wall of the peripheral airways.Excessive mucous production and accumulation. Partial or total mucous plugging of the airways. Smooth muscle constriction of bronchial airways(bronchospasm).Airtrapping/hyperinflatio
Etiology of Chronic Bronchitis that inhalation of cigarette smoke is the most important factor that generates chronic bronchitis. Other noxious agents about which there are still controversial opinions, are air pollution and occupational inhalants.
Pathology of Chronic Bronchitis The pathology of chronic bronchitis includes an inflammatory mononuclear cell infiltrate in the airway wall and a neutrophil influx into the airway lumen.
Treatment of Chronic Bronchitis bronchodilator medications, steroids, antibiotics, oxygen therapy, vaccines, surgery, and pulmonary rehabilitation.
Etiology of Acute Bronchitis Influenza,Parainfluenza, coronavirus, rhinovirus, RSV, human metapneumovirus
Clinical manisfestation of acute bronchitis Cough with sputum production Typically lasts 10-20 days 50% will have purulent sputum, Bronchospasm (improves in 5-6 weeks)FEV1 reduced in 40% of patients
Give the medical term for an increase in tissue volume with the addition of new cells Hyperplasia
Medical term for an increased term for an increased in tissue volume as a result of enlargement but not increased the number of new cells Hypertrophy
Define emphysema Presence of permenant enlargement of the airspaces distal to the terminal bronchials accompanied by distraction of the walls and without obvious fibrosis
Indentify the genetic deficiency of a serum compound that can lead to emphysema Alpha1 Antitrypsin Deficiency
Etiology of emphysema Cigarette smoking, inhaled irritants, Infection, hereditary and age
Clinical manifestations of emphysema Barrel Chested pursed-Lip Breathing Use of Accessory Muscles Hyperresonant to percussion Breathsounds -Diminished Crackles or wheezing
Radiographic changes of emphysema Translucent – Dark Depressed flatteningof diaphragms Hyperinflation Increased Retrosternal air spaces separation of the aorta and sternum the heart often appears long and narrow as a result of being drawn downward by the descending diaphragm
Pathology of emphysema Loss of lung recoil due to loss of elastic tissues Increased lung compliance Decreased expiratory flows Instability of small airways due to loss of nearby support tissue Air trapping; Increased FRC, RV & TLC
What is GOLD? Global Initiative for Chronic Obstructive Lung Disease; is recognized as a worldwide leading authority for the diagnosis,management, and prevention on COPD
Pathologic or Structural changes with Emphysema Permanent enlargement and deterioration of airspace’s distal to the terminal bronchioles. Destruction of elastic fibers Destruction of pulmonary capillaries. Airflow obstruction from loss of airway tethering and radial traction.
Give the medical term for an increase in tissue volume with the addition of new cells hyperplasia
Give the medical term for an increase in tissue volume with a result of ENLARGEMENT but NOT increase in the number of new cells hypertrophy
Describe the changes seen in a patients ABGs that have Emphysema The DLCO (diffusion capacity) is decreased
Describe the changes seen in a patients ABGs that have Chronic Bronchitis
Give the first and most common change in the patients ABGs in Emphysema increased CO2
List 3 categories of Bronchodialators used in treatment for COPD Beta2-Agonists Anticholinergics
List 2 drugs used with obstructive lung disease that are NOT bronchodilators oxygen therapy corticosteroids antibiotics
The key indicators for considering a COPD diagnosis are Dyspnea chronic cough chronic sputum production history of exposure to risk factors such as tobacco smoke
3 main spirometry test used to identify COPD Forced Vital Capacity (FVC) Forced Expiratory Volume in 1 second (FEV1) Forced exp. vol. in 1 sec/forced vital capacity ratio (FEV1/FVC ratio) aka (FEV1%)
Describe the changes seen in a patients ABGs that have Emphysema or Chronic Bronchitis from stage I to IV Stage I alkalotic pH, CO2 acidic, HCO3 acidic, PaO2 is decreased (someone who is hyperventilating) Stage IV pH is within normal range, CO2 acidic, HCO3 alkalotic, PaO2 decreased (hypoxic)
Describe the management of the patient with Emphysema with the ABGs, pH 7.36 PaCO2 65 PaO2 50 leave them alone because they are COPD and the pH is within normal range….??? give him O2 therapy and treat the underlying cause maybe give a bronchodilator to get the PaO2 up to 60
Loss of tractional support Emphysema
Alveolar destruction Emphysema
Inflammation Chronic Bronchitis
Mucous plugs Chronic Bronchitis
Smooth muscle spasm Chronic Bronchitis
Elastic Recoil in Emphysema decreased
Residual Volume in Emphysema increased
total lung capacity in emphysema increased
FEV1 in emphysema decreased
FVC in emphysema decreased
FEV1/FVC% in emphysema decreased
DLCO (diffusion capacity) in emphysema decreased
Elastic recoil in Chronic Bronchitis normal
Residual volume in Chronic Bronchitis increased
Total Lung Capacity in Chronic Bronchitis increases
FEV1 in Chronic Bronchitis decrease
FVC in Chronic Bronchitis decrease
FEV1/FVC% in Chronic Bronchitis decrease
DLCO (diffusion capacity) in Chronic Bronchitis often normal
The barrel chest is a physical sign of what? emphysema
In chronic bronchitis what airways are affected first? large airways (bronchi)
Term used to describe right sided heart failure secondary to pulmonary disease cor pulmonae
The patient with chronic bronchitis is susceptible to what? respiratory infections
Pink Puffer Type A COPD; derived from the reddish complexion and the “puffing” (pursed-lip breathing) commonly seen in patients with Emphysema. Pts usually thin. Marked dyspnea.
Blue Bloater Type B COPD;the term is derived from the cyanosis commonly seen in patients with Chronic Bronchitis. Pts tend to be stocky and overweight. HYPOventilation common. secondary polycythemia, CO2 retention,pulmonary hypertension, and cor pulmonale
Auscultation in Emphysema decreased breath sounds decreased heart sounds prolonged expiration
Auscultation in Chronic Bronchitis wheezing crackles rhonchi,depending on severity of disease
Percussion in Emphysema Hyperresonance
Percussion in Chronic Bronchitis Normal
What are the two types of emphysema? centrilobular and panlobular
centrilobular emphysema this type of emphysema is associated primarily with cigarette smoking and affects mainly the respiratory bronchioles
panlobular emphysema cause more often by a hereditary deficiency of the enzyme inhibitor alpha – antitrypsin,affects the respiratory bronchioles and the alveoli.
Pockets of air located between the alveolar spaces bullae
What percentage of all cases of COPD is caused by an A1-antitrypsin deficiency? 2%-3%
According to the GOLD report, which of the following is the greatest worldwide risk factor for COPD tobacco smoke
Which of the following are anatomic alterations found with chronic bronchitis Increased size of submucosal bronchial glands Chronic bronchial wall inflammation Bronchospasm
Which of the following are anatomic alterations found with emphysema? Weakened distal airways Decreased surface area for gas exchange Hyperinflation
Which of the following medications is indicated for REGULAR use in patients with stable COPD B2-agonists
A patient with chronic bronchitis will have which of the following clinical manifestations Cough Stocky, overweight build Cor pulmonale Rhonchi
What treatment below for patients with COPD has been shown to improve long-term survival oxygen
Chronic obstructive pulmonary disease (COPD) includes which of the following conditions Chronic Bronchitis Emphysema
A patient is experiencing an exacerbation of COPD. He is 65 years old, fairly slim, and in notable distress with tachypnea, tachycardia, and an arterial blood pH of 7.20. Which of the following therapies would be most indicated? noninvasive ventilation
Emphysema -is most closely associated with Chronic Bronchitis -leads to the destruction of alveolar walls
Which of the following would indicate a diagnosis of advanced COPD -Arterial blood gases show low O2 and high CO2 -Pulmonary function tests show low flow of air on expiration
Emphysema is probably caused by all of the following EXCEPT: inhaling asbestos fibers
At which stage of COPD does the patient usually first seek medical attention because of worsening symptoms? Stage IIMost patients will seek medical attention when they begin to feel serious symptoms such as shortness of breath or chronic cough during Stage II of COPD. Stage I symptoms are not bad enough for most patients to see a physician.
Which form of Obstructive Lung Disease is most common Chronic Bronchitis
Which of the following is true of the diffusing capacity test (DLCO) findings in a patient with COPD decreased in emphysema
Chronic bronchitis is defined as -daily productive cough for 3 months -for 2 years in a row
What is the benefit of pulmonary rehabilitation in patients with moderate to severe COPD improves exercise tolerance
What are the primary structures affected by chronic bronchitis conducting airways (The conducting airways (bronchi) are primarily affected by chronic bronchitis. The alveoli, pulmonary capillaries, and goblet cells are affected to a lesser extent)
Which of the following terms is/are commonly applied to a patient with emphysema Type A COPD Pink Puffer
It is not clear whether your patient has COPD or asthma. Which of the following characteristics is most closely associated with the diagnosis of asthma? normalization of the FEV1 after use on a bronchodilator
A patient with emphysema will often have the following clinical manifestations Barrel Chest pursed-lip breathing
The management of chronic obstructive pulmonary disease (COPD) includes: bronchopulmonary hygiene procedures smoking cessation lung volume-reduction surgery annual influenza immunization
Which of the following are associated with chronic bronchitis right heart failure purulent sputum elevated CO2 levels cyanosis
“I coughed hard all night long.” “My chest feels very tight.” “I feel very short of breath.” Subjective information presented by the patient
Objective information that can be measured, factually described, or obtained from other professional reports or test results. Heart rate Respiratory rate Blood pressure Temperature Breath sounds Cough effort
Professional conclusion about the cause of the subjective and objective data. The assessment of bronchospasm can be concluded from wheezes.  Or, acute ventilatory failure with moderate hypoxemia can be inferred from the following ABGs pH:7.18 • PaCO2 80 mm Hg • HCO3 29 mEq/L • PaO2 54 mm Hg
Plan is the therapeutic procedure(s) selected to remedy the cause identified in the assessment. For example: An assessment of bronchial smooth muscle constriction justifies the administration of a bronchodilator  The assessment of acute ventilatory failure justifies mechanical ventilation
common cause of Respiratory acidosis *abnormalities in pulmonary ventilation leading to CO2 retention. *Halted or hindered gas exchange *Obsructions preventing exhalation of CO2 *Impaired neuromuscular function or integerity of chest wall *Depressed Respiratory center in medulla
Etiology of Respiratory acidosis ARDS, Pneumonia, Atelectasis, COPD, emphysema, asthma, bronchial burns, chest trauma, Guillain-Barre, MS, Mysathenia gravi, Drug overdoses, anesthesia, acute alcoholism
Compensatory mechanisms that take place within 24 hours of Respiratory Acidosis Kidneys conserve HCO3 and excrete more hydrogen ions into urine Urine becomes more acidotic
Clinical manisfestations or signs of respiratory acidosis Drowsiness, unconsciousness, disorientation, rapid, shallow respirations, tachycardia, dizziness, decreased BP, headache, Tachycardia, seizures
s/s of hypoxemia • tachypnea • tachycardia (1st sign of hypoxemia) • cyanosis • accessory muscles
normal ranges for adult respirations? 12-20 breaths/min
normal range for adult pulse rate? 60-100 bpm
normal range for adult systolic bp 110-140
normal range for adult diastolic bp 60-90
SpO2 for severe hypoxemia less than 85%
treatment for severe hypoxemia? admin of O2 and/or ventilatory support
wheezing is a sign of airway obstrruction
coarse crackles indicate CHF, pulmonary edema, pneumonia with severe congestion and COPD
pulmonary edema the collection of fluid in the alveoli, particularly dangerous because it impedes gas exchange. common causes of pulmonary edema are increased pulmonary blood pressure or infection of the respiratory system.
Congestive Heart Failure failure of the left ventricle to pump an adequate amount of blood to meet the demands of the body, resulting in a “bottleneck” of congestion in the lungs that may extend to the veins, causing edema in lower portions of the body
during the advanced stages of emphysema what does the PaO2 and PaCO2 show chronically low PaO2 and high PaCO2
hypoxemia a decreased arterial oxygen level
type of pulmonary shunting associated with CB and Emphysema? Relative or Shuntlike effect
Peripheral Edema is commonly seen in patients with CHF, Cor Pulmonale, hepatic cirrhosis
Repeated expectoration of blood-streaked sputum is seen in CB,bronchiectasis, CF, embolism, lung cancer, TB and fungal diseases
common causes of non productive cough tumors, irriation of the airways, mucous accumulation, irritation of the pleura
normal tidal volume for an adult 400-500 ml
restrictive lung disease tumor, pulmonary fibrosis, scarring, neumonia, chest wall stifness, respiratory muscle weakness and central nervous system diseases, musculoskeletal, sarcoidosis, inhaling toxic fumes, decrease in lung compliance, decreased lon volumes tlc, vc irv tv erv
normal acid base balance? 1:20
Sa02 normal values 96-100%
DLCO test how well gases(oxygen) move through the lungs and into the blood stream
CXR for Chronic Bronchitis hyperinflation
Expected Sa02 and PaO2 90 : 60 80 : 50 70 : 40 *PaO2 100 SaO2 98

Question Answer
Normal lung-mode VC or PC-CMV
Normal lung-Vt 10-12ml/kg IWB
Normal lung-rate 8-12bpm
normal lung-flow 60LPM
normal lung-waveform Descending or constant
Normal lung-Ti 1 sec
Normal lung-PEEP 3-5cm H2O
normal lung-FIO2 less than 50%
COPD-mode VC or PC-CMV
COPD-Vt 8-10ml/kg IBW
COPD-rate 8-12bpm
COPD-flow 80-100 LPM
COPD-waveform descending or constant
COPD-Ti 0.6-1.2 sec
COPD-PEEP 3-5cmH2O or 50% of occult PEEP
COPD-FIO2 less than 50%
neuromuscular-mode VC-CMV
neuromuscular-Vt 12-15ml/kg IBW
neuromuscular-rate 8-12bpm
neuromuscular-flow at or above 60LPM
neuromuscular-waveform descending or constant
neuromuscular-Ti 1sec
neuromuscular-PEEP 5cmH2O
neuromuscular-FIO2 21%
asthma-mode VC or PC-CMV
asthma-Vt 4-8ml/kg IBW
asthma-rate <8bpm
asthma-flow 80-100LPM
asthma-waveform descending
asthma-Ti 1 second or less
asthma-PEEP only to offset auto PEEP
asthma-FIO2 50% or greater
closed head-Vt 8-12ml/kg IBW
closed head-mode PC or VC-CMV
closed head-rate 15-20bpm
closed head-flow 60LPM
closed head-waveform descending or constant
closed head-Ti 1sec
closed head-PEEP 0-5 use with caution
closed head-FIO2 100%
ARDS-mode PC or VC-CMV
ARDS-Vt 4-8ml/kg IBW
ARDS-rate 15-25bpm
ARDS-flow 60LPM or greater
ARDS-Ti 1sec
ARDS-waveform descending or constant
ARDS-PEEP 5->15cmH2O
ARDS-FIO2 100%
CHF-mode VC or PC-CMV
CHF-Vt 8-10ml/kg IBW
CHF-rate 15-25bpm
CHF-waveform descending or constant
CHF-flow 60LPM or greater
CHF-Ti 1-1.5sec
CHF-PEEP 5-10cmH2O
CHF-FIO2 100%

Question Answer
what is guillain barre syndrome? Relatively rare disorder of the peripheral nervous system in which flaccid paralysis of the skeletal muscles and loss of reflexes develop in previously healthy pt.
Major patho and structural changes of GB syndrome? Mucus accumulation,Airway obstruction,Alveolar consolidation, Atelctasis
Etiology of GB syndrome? not known. Onset frequently occurs 1-4 weeks after a febrile episode like a upper respiratory or GI illness.
signs of GB include? paresthesias, paralysis, CSF findings, abnormal EMG results (EMG measures the nature and speed of electrical conduction along a nerve). CSF will have abnormally high protein level w/ normal cell count
Functional spontaneous recovery for GB syndrome is expected how often? in about 85% to 95% of the cases, although approx 40% of might have minor residual symptoms
common noncardiopulmonary symptoms of GB? Progressive ascending paralysis of the skeletal muscles – usually develop during a single day though can happen over a few days and generally peaks in fewer than 10 days
What are Early symptoms of GB: fever, malaise, nausea, prostration w/ distal paresthesia
what are chest assessment findings common for GB? diminished breath sounds, crackles and rhonchi
what treatment can be used for GB? Plasmapheresis(5 exchanges of 3 L each over 8-10 days is usually adequate.), Infusion of immunoglobulin, Corticosteroids
characteristics of GB? Tingling sensation and numbness (distal paresthesia),Loss of deep tendon reflexes,Sensory nerve impairment, Peripheral facial weakness, Dec gag reflex, Dec ability to swallow
what is myasthenia gravis? Chronic disorder of the neuromuscular junction that interferes w/ the chemical transmission of ACH btw the axonal terminal and the receptor sites of voluntary muscles.,Disorder affects the myoneural junction (motor), sensory function not lost
major P&S changes for MG? Mucus accumulation,Airway obstruction, Alveolar consolidation, Atelecatasis
what is the etilogy of MG? cause appears to be related to circulating antibodies of the autoimmune system (anti-ACH receptor antibodies).
MG is Most common in? young women and older men.disease usually has peak onset in females between 15 and 35 years, compared w/ 40 to 70 years in males.
what are Clinical manifestations associated w/ myasthenia gravis? often provoked by emotional upset, physical stress, exposure to extreme temp changes, febrile illness, pregnancy
diagnosis of MG is based on? clinical history, neuro exam, electromyography, blood analysis, edrophonium test, CT scan, MRI
signs and symptoms of MG include: facial muscle weakness, double vision, difficulty in breathing, talking, chewing or swallowing, muscle weakness in arms and legs, fatigue brought on by repetitive motions, also speech impairment
what is Edrophonium test? MG is usually confirmed w/ the injection of edrophonium (tensilon).
what are Common noncardiopulmonary manifestations of MG? Weakness of striated muscles(ptosis,diplopia,speech impairment,dysphagia), gradual onset,
what are first symptoms of MG? Ptosis followed by diplopia caused by weakness of the external ocular muscles
what should be Frequently measured for MG? pt’s vital capacity, blood pressure, oxygen saturation, and ABG
When should Mech vent should be initiated for MG? when the pt’s clinical data demonstrate impending or acute ventilatory failure.
what are the actions of Cholinesterase inhibitors used for MG? It inc the concentration of ACH to compete w/ the circulating anti ACH antibodies, which interfere w/ the ability of ACH to stimulate the muscle receptors
how are immunosuppressants used for MG? -corticosteroids e.g. prednisone and similar agents such as cyclophosphamide (cytoxan, neosar) and azothioprine (imuran) are used to suppress the immune system
what is Thymectomy used for in MG? the thymus gland frequently appears to be the source of anti-ACH receptor antibodies- in some pts, muscle strength improves soon after surgery, whereas in others improvement takes months or years.
how is Plasmapheresis used for in MG? blood plasma exchange procedure is used to filter the blood of ACH receptor antibodies
MG is specifically characterized by? fatigue and weakness, w/ improvement following rest.
The cause of MG is believed to concern antibodies. It is believed that the antibodies disrupt the chemical transmission of ACH at the neuromuscular junction by? 1. blocking the ACH from the receptor sites of the muscular cell, 2. accelerating the breakdown of ACH, 3. destroying the receptor sites
what is seen after the administration of tensilon in a person with MG muscular weakness? a dramatic transitory improvement in muscle function (lasting about 10 min)
what are the most popular cholinesterase inhibitors? most popular agents are edrophonium chloride , neostigmine , pyridostigmine
how does tensilon work? it blocks cholinesterase from breaking down ACH after it has been released from the terminal axon. Action inc the myoneural concentration of ACH, which in turn offsets the influx of antibodies at the neuromuscular junction.
edrophonium chloride (tensilon),
neostigmine (prostigmin)
pyridostigmine (regonol, mestinon)
patho and structural changes associated w/ ARDS are: Interstitial and intra-alveolar edema and hemorrhage, Alveolar consolidation, Intra-alveolar hyaline membrane, Pulmonary surfactant deficiency or abnormality, Atelectasis
what is the Gross appearance of patients with ARDS? lungs look heavy and red, beefy or liver like
ARDS is rest/obstr? Restrictive lung disorder
what was ARDS Historically referred to as? “shock lung syndrome” when disease first identified in WWII
in ARDS the intra-alveolar walls become lined w/ a thick, rippled hyaline membrane identical to the hyaline membrane seen in newborns w/ infant respiratory distress syndrome-
the hyaline membrane seen in ARDS contains contains fibrin and cell debris
etiologies of ARDS #1 Aspiration,Cardiopulmonary bypass,CHF, Disseminated-intravascular coagulation,Drug overdose,Fat or air emboli, Fluid overload, Infections,Inhalation of toxins and irritants,Immunologic reaction,Massive blood transfusion,
what is Disseminated-intravascular coagulation? seen in pts w/ shock, it is a condition of paradoxical simultaneous clotting and bleeding that produces microthrombi in the lungs
what is Septic shock is caused by Infection in blood,Blood vessels dilate,Blood pressure drops
what are clinical manifestations of ARDS? atelectasis, alveolar consolidation and inc a-c membrane thickness
what will a chest assessment of ARDS sound like? dull percussion note, bronchial B.S., crackles
a mild to moderate ABG of ARDS looks like inc pH, dec all else
a severe/acute ventilatory ABG of aRDS looks like dec pH, inc Paco2, inc Hco3, dec Pao2
the chest xray for ARDS shows? increased opacity (whiteness)
what will the mech vent settings be for ARDS? low tidal volume and high RR with PEEP. 4-8 ml/kg and 35 bpm
what is the goal of low tidal volume ventiltilation is to dec high transpulmonary pressure, reduce overdistention of the lungs, dec barotrauma
etiologies of ARDS #2 Nonthoracic trauma,Oxygen toxicity,Pulmonary ishcemia,Radiation induced lung injury,Shock, Thoracic trauma, Uremia
Interstitial lung diseases comprise a large group of pulmonary disorders that are all associated w/ pulmonary inflammatory changes
CILD rest/obst? it Is both restrictive and obstructive disorder or both at the same time
Major patho and structural changes of CILD? Fibrotic thickening of the respiratory bronchioles and alveoli, Granulomas, Destruction of the alveoli and adjacent pulmonary capillaries, Honeycombing and cavity formation, Airway obstruction caused by inflammation and bronchial obstruction
another name for Extrinsic allergic alveolitis is hypersensitivity pneumonitis
Extrinsic allergic alveolitis aka hypersensitivity pneumonitis is the immunologically mediated inflammation of the lungs caused by the inhalation of a variety of antigens like pollen, animal dander, organic dusts, and spores of certain molds. Based on a hypersensitivity reaction
what is an example of Extrinsic allergic alveolitis? Farmers lung- extrinsic allergic alveolitis caused by inhalation of moldy clay
Idiopathic pulmonary fibrosis is a progressive inflammatory disease w/ varying degrees of fibrosis and in severe cases, honeycombing. The precise etiology is unknown.
other names for IPF are acute interstitial fibrosis of the lung, cryptogenic fibrosing alveolitis, hamman-rich syndrome, honeycomb lung, interstitial fibrosis, interstitial pneumonitis
Desquamative interstitial pneumonia (DIP) type of IPF? hyperplasia, desquamation of alveolar type II cells, alveolar spaces are packed w/ macrophages, even distribution of interstitial mononuclear infiltrate. Better prognosis than UIP
Usual interstitial pneumonia (UIP)type of IPF? interstitial and alveolar wall thickening caused by chronic inflammatory cells and fibrosis
what is seen in severe cases of UIP? alveolar walls become fibrotic, honeycombing, inflammatory infiltrate is reduced
who is IPF seen in? Seen most in males between 40 and 70
how is Diagnosis of IPF confirmed? by open lung biopsy
what is Rheumatoid arthritis? primarily an inflammatory joint disease.
How is rheumatoid arthritis a CILD (how does it affect the lungs?) May involve the lungs in the form of pleurisy (w/ or w/o effusion), interstitial pneumonitis, necrobiotic nodules (w/ or w/o cavities), caplan’s syndrome, pulmonary hypertension secondary to pulmonary vasculitis, pneumoconiosis
what is the most commonly pulmonary complication associated w/ rheumatoid arthritis? Pleurisy w/ or w/o effusion
Pleurisy is progressive inflammation of the parietal pleura
what is Systemic lupus erythematosus? multisystem disorder that mainly involves the joints and skin. Also may cause problems in the kidneys, lungs, nervous system and heart.
how many cases of lupus involve the lungs? 50-70% of cases involves the lungs
what are the Pulmonary manifestations of lupus characterized by pleurisy w/ or w/o effusion, atelectasis, diffuse infiltrates and pneumonitis, diffuse intersitial lung disease, uremic pulmonary edema, diaphragmatic dysfunction, infections
what is the most common pulmonary complication of lupus? Pleurisy w/ or w/o effusion
Caplan’s syndrome aka rheumatoid pneumoconiosis progressive pulmonary fibrosis of the lung commonly seen in coal miners
what is Goodpasture’s syndrome? disease of unknown etiology that involves two organ systems- the lungs and the kidneys.
how does goodpasture’s syndrome affect the lungs? recurrent episodes of pulmonary hemorrhage and in some cases, pulmonary fibrosis- presumably as a consequence of the bleeding episodes
how does goodpasture’s syndrome affect the kidneys? glomerulonephritis characterized by the infiltration of antibodies within the glomerular basement membrane
good pasture syndrome is usually seen in? young adults
what is the Average survival period after diagnosis of good pasture’s syndrome? 15 weeks. About 50% of pts die form massive pulmonary hemorrhage, and about 50% die from chronic renal failure
Bronchiolitis obliterans w/ organizing pneumonia- called BOOP is characterized by connective tissue plugs in the small airways and mononuclear cell infiltration of the surrounding parenchyma
etiology of BOOP> Considered idiopathic, but is associated w/ connective tissue disease, toxic gas inhalation, and infection.
Xray of BOOP commonly shows? patchy infiltrates of alveolar rather than intersitial involvement
what are the chest assessment findings for CILD? inc tactile and vocal fremitus, dull percussion, bronchial B.S., crackles
what are the chest xray findings? bilateral infiltrates, granulomas, cavity formation, honey combing, air bronchograms, pleural effusion
All expiratory maneuver findings (eg FVC, FEV, FEF)? decreased
what are the lung volume and capacity findings (eg Vt, RV, FRC)? all decreased except RV/TLC
what are used for treatments for CILD? corticosteroids and plasmapheresis
what disorders are associated with interstitial inflammation accompanied by granuloma formation? extrinsic allergic alveolitis, sarcoidosis, churg-strauss syndrome
what happens in Severe cases of GB? paralysis of diaphragm and ventilatory failure- medical emergency
microscopically what is seen in GB?] nerves show demyelination, inflammation and edema
serum samples taken from GB patients show high antibody titers
if GB is diagnosed early, what is prognosis? excellent
the diagnosis of GB is based on patient’s clinical history
GB is more common in: people older than 45 yo, males
Non REM sleep- usually begins immediately after an individual dozes off. Consists of four separate stages, each progressive into deeper sleep
in non REM sleep During stages 1 and 2 vent rate and tidal volume continually inc and dec and brief periods of apnea seen. Cheyne stokes breathing seen in older males
in non REM sleep During stages 3 and 4 ventilation becomes slow and regular. Minute volume is commonly 1 to 2 lpm less. PaCO2 levels are higher (4-8 mm hg), PaO2 levels are lower (3-10 mmhg) and the pH is lower (.03-.05 units)
non REM sleep Lasts 60-90 minutes.
Most of non REM sleep time is spent in stage 2. person may move into REM sleep at any time though it occurs most often before stage 1 and 2
during REM sleep-vent rate is rapid and shallow, dreaming occurs
during REM sleep the Muscle paralysis that occurs can affect ventilation is two ways Bc the muscle tone of the intercostal muscles is low, the neg intrapleural pressure generated by the diaphragm often causes a paradoxical motion of the rib cage;Loss of muscle tone in the upper airway leads to obstructions
REM sleep Lasts between 5-40 mins, approx every 60-90 min
REM sleep’s frequency durign sleep time? Lengthen and become more frequent toward the end of the night’s sleep,Consitutes about 20-25% of the total sleep time, Studies show that it is more difficult to awaken a subject during REM sleep
Apnea cessation of breathing for a period of 10 seconds or longer
Sleep apnea is diagnosed in pts who have more than 5 episodes of apnea per hour that may occur in either or both non REM or REM sleep, over a 6 hour period.
generally, the episodes of apnea per hour are more frequent and severe during REM sleep and in the supine body position
Obstructive sleep apnea is caused Caused by an anatomic obstruction of the upper airway in the presence of continued ventilatory effort.most commonly encountered
OSA is Characterized by presence of heightened inspiratory efforts during apneic periods, Apneic episodes followed by increasingly desperate efforts to inhale
during OSA “fricative” breathing is snorting sound may be heard at end of apneic periods
in OSA’s Severe cases pt may awaken and sit upright and gasp for air
OSA Pts usually demonstrate perfectly normal and regular breathing patterns during wakeful period
OSA is Seen more commonly in males, esp middle aged men. Approx 1-4% of adult male population appear to be affected.
Pickwickian syndrome and OSA excessive daytime sleepiness- associated with Joe the fat boy from Charles Dickens’s The PostHumous papers of the Pickwick club
Some clinical disorders associated with OSA: Obesity,,Anatomic narrowing of upper airway,Deviated nasal septum, or allergic rhinitis, causing mouth breathing, Hypothyroidism,Down syndrome
Clinical manifestations of OSA Chronic loud snoring,Hypertension,Morning headaches,Systemic hypertension,CHF, Nausea,Dry mouth on awakening
Polysomnographic monitoring demonstrates the following in OSA Apnea-related O2 desaturation-4% or greater drop in SpO2;More than 5 obstructive apneas of more than 10 sec per hour of sleep, and one or more of the following: Frequent arousals, Profound bradycardia and/or asystole,Shortened sleep latency
Central sleep apnea occurs when respiratory centers of the medulla fail to send signals to the respiratory muscles
CSA is Characterized by cessation of airflow at the nose and mouth along w/ cessation of inspiratory efforts (absence of diagphragmatic excursions)
CSA is Diagnosed when the frequency of the apnea episodes is excessive (more than 30 in a 6 hour period)
General noncardiopulmonary clinical manifestations of central sleep apnea can be summarized as follows Tendency for the pt to be of normal weight, Mild snoring,Insomnia,Daytime fatigue
Diagnosis of CSA begins w/ a careful history from the pt, esp noting the presence of snoring, sleep disturbance, persistent daytime sleepiness,Blood is evaluated for polycythemia, reduced thyroid function, bicarbonate retention,ABGs
Chest xray, ECG, and echocardiogram helpful in CSA in evaluating the presence of pulmonary hypertension, the state of right and left ventricular compensation, and the presence of any other cardiopulmonary disease
Diagnosis and type of sleep apnea is confirmed w/ polysomnographic sleep studies
Polysomnographic studies include: An EEG and electro-oculogram (EOG) to identify sleep stages,Use of monitoring device for airflow in and out of pt’s lungs,An ECG ,Impendance pneumography, intercostal electromyography, esophageal manometry,Ear oximetry or transcutaneous oxygen monitoring
Pts diagnosed as having OSA may undergo a CT scan or head xray to determine site and severity of pharyngeal narrowing
Steps typically involved in diagnosing sleep apnea can be summarized as History, Exam of the neck and upper airway structures, heart and lungs,Spirometry (FV loops in the erect and supine positions) to assess for extrathoracic airway obstruction , ABG, Hemoglobin and carboxyhemoblogin levels, Nocturnal recording oximetry
in sleep apenea, the ABG looks Ph normal, paco2 inc, hco3 inc significantly, dec pao2
Negative pressure ventilation is used for which type of sleep apnea for pts with central sleep apnea
what is def of Drowning? suffocation and death as a result of submersion in liquid.
def of Near drowning? victim survives liquid submersion, at least temporarily
def of Dry drowning? glottis spasms and prevent water from passing into the lungs. Lungs are usually normal
def of Wet drowning? glottis relaxes and allows water to flood the TBT and alveoli. When fluid is initially inhaled, the bronchi constrict in response to parasympathetic reflexes- then the patho processes responsible for noncardiogenic pulmonary edema begin
If a victim was submerged in unclean water, pathogens and solid material may be aspirated.can lead to pneumonia and ARDS
Major pathologic changes of the lungs in near drowning are the same in fresh water and sea water -both result in reduction in pulmonary surfactant, alveolar injury, atelectasis and pulmonary edema
how many people drown each year? Between 6000 and 8000 people drown each year in the US.
Children under the age of 5 account for 40% of deaths. Additional 20% of deaths occur in ages between 5 and 20
the major P&S changes of near drowning are: laryngospasm and bronchial constriction, intersitial edema including engorgement of the perivascular and peribronchial spaces, alveolar walls and interstitial spaces, dec pulmonary surfactant, inc surface tension, atelectasis, frothy white secretions
clinical manifestations of near drowning? atelectasis, alveolar consolidation, inc a-c membrane, bronchospasm
in near drowning apnea is related to the length of time the victim is submerged
what are the chest assessment findings of near drowning? crackles and rhonchi
what does the ABG look like in the early and advanced stages of near drowning? low pH, high Pa2, low HCO3 (lactic acidosis is common), low Pao2
First objective by first responder is to remove the person from the water and if the pt has no spontaneous ventilation and pulse, to call for help and immediately initiate CPR,Should be wrapped in warm, dry coverings
If pt has been submerged for less than 60 mins in cold water, fixed and dilated pupils means does not necessarily mean poor prognosis
Virtually every near drowning victim suffers from hypoxemia, hypercapnia, acidosis
The degree of hypoxemia is directly related to the amt of a-c damage-chest xray should be obtained
Intubation and mech vent should be performed immediately for anyone w/ no spontaneous breathings or pts who are unable to maintain a PaO2 of 60 mmhg w/ a FIO2 of .5 or lower.
For wet drowning, how should ventilation be handled? mech vent w/ PEEP or CPAP should be administered
radiographic deterioration may occur in near drowning pts within first 48-72 hours
what is Thermal injury injury caused by inhalation of hot gases. Usually confined to upper airway-nasal cavity, oral cavity, nasopharynx, oropharynx, larynx
Airways distal to the larynx and the alveoli are usually spared serious thermal injury bc of The remarkable ability of the upper airways to cool hot gases, Reflex laryngospasm, Glottic closure
what is classic predictor of thermal injury? Presence of facial burns
Thermal injury to the distal airways results in mucosal edema, vascular congestion, epithelial sloughing, obliterative bronchiolitis, atelectasis, pulmonary edema
Direct thermal injuries usually do not occur below the level of the larynx, except in the rare instance of steam inhalation.
in Early stage (0-24 hours postinhalation)of smoke inhalation injury TBT becomes more inflamed initially. Process causes an overabundance of bronchial secretions to move into the airways, resulting in bronchospasm. Also, smoke slows down the mucociliary escalator which inc mucus retention
Smoke inhalation may also cause noncardiogenic high permeability pulmo edema- “leak alveoli”
Intermediate stage (2-5 days postinhalation) Necrotic debris, excessive mucus production, and mucus retention lead to mucus plugging and atelectasis. Mucus accumulation also leads to bacterial colonization, bronchitis, pneumonia.
Organisms commonly cultured from smoke inhalation injury are gram positive staph, gram negative klebsiella, enterobacter, e. coli, pseudomonas.
Noncardiogenic pulmo edema and ARDS may develop at any time during intermediate period
When chest wall burns are present, situation may be further aggravated by the pts’ inability to breath deeply and cough as result of pain, use of narcotics, immobility, inc airway resistance, dec lung and chest compliance.
Late stage (5 or more days postinhalation) Infections resulting from burn wounds on the body surface are the major concern during this period- infections often lead to sepsis and multiorgan failure,Pneumonia and pulmo embolism may cause problems
Sepsis induced multiorgan failure is primarily cause of death in what stage? late stage post inhalation
Long term effects of smoke inhalation rest/obst? both
Restrictive lung disorder- develops from alveolar fibrosis and chronic atelectasis
Obstructive lung disorder- caused by inc and chronic bronchial secretions, bronchial stenosis, bronchial polyps, bronchiectasis, bronchiolitis.
Major patho and structural changes of Thermal injury upper airway-nasal cavity, oral cavity, pharynx: blistering, mucosal edema, vascular congestion, epithelial sloughing, thick secretions, acute UAO
major P&S changes of Smoke inhlations injury TBT, alveoli: inflammation of TBT, bronchospasm, excessive bronchial secretions and mucus plugging, dec mucosal ciliary transport, atelectasis, alveolar edema and frothy secretions, ARDS, BOOP, alveolar fibrosis, bronchiectasis
The prognosis of fire victims usually is determined by 1. extent and duration of smoke exposure, 2. chemical composition of the smoke, 3. size and depth of body surface burns, 4. temp of gases inhaled, 5. age, 6. pre-existing health status
When smoke inhalation injury is accompanied by a full thickness or third degree skin burn, the mortality rate almost doubles
First degree (min depth to skin) superficial burn, damage limited to the outer layer of the epidermis. Burn characterized by red skin, tenderness, pain. No blisters. Healing time: 6-10 days. Result of healing: normal skin.
Second degree (superficial to deep thickness of skin) burns in which damage extends through the epidermis and into the dermis but not sufficient enough to interfere w/ regeneration of epidermis. Blisters present. Healing time: 7-21 days.
Third degree (full thickness of skin including tissue beneath skin): burns in which both epidermis and dermis are destroyed, w/ damage extending into underlying tissues. Tissue may be charred or coagulated.
Principal goals in initial care of smoke inhalation and thermal injuries: immediate assessment of pt’s airway, respiratory status, CV status, percentage of body burned, depth of burns, IV line should be started immediately to admin fluids and meds, Clothing should be removed or soaked, burn wounds covered,Infection control
Fluid resuscitation w/ ringer’s lactate solution is usually initiated according to the parkland formula which is? 4 ml/kg of body weight for each percent of BSA burned over a 24 hour period.
The pts’s hemodynamic status will usually remain stable at this fluid replacement rate, w/ an avg urine output target of 30-50 ml/hr
The pts’s hemodynamic status will usually remain stable at this fluid replacement rate,and a central venous pressure target of 2-6 mm hg.
fluid resuscitation can lead to overhydration and acute upper airway obstruction and pulmo edema
If secondary infection occurs during second degree burn, damage may be equal to a third degree burn.
Result of healing during second degree burn? normal to hairless and depigmented skin w/ texture that is normal, pitted, flat or shiny
Healing of third degree burns: may occur after 21 days or never occur w/o skin grafting if area is large.
Results of third degree burn hypertrophic scares (keloids) and chronic degranulation.
fluid resuscitation can lead to] overhydration and acute upper airway obstruction and pulmo edema