CMD - Dyspnea Flashcards by 18 22

subjective experience of breathing discomfort that consists of qualitatitively distinct sensations that vary in intensity

Dyspnea

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The motor cortex responding to unput from the control center sends neural messages to the ventilator muscle and a ____ to the sensory cortex

corollary discharge

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respiratory sensations are the consequence of interactions between the efferent or outgoing, motor output from the brain to the ventilatory musces

a. feedforward
b. feedback
c. corollary discharge
d. NOTA

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afferent, or incoming, sensory input from receptors throughout the body (feedback)

a. feedforward
b. feedback
c. corollary discharge
d. NOTA

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3 impulses in the sensory cortex

feedback
feedforward
error signa

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4 afferents to the sensory cortex

Chemoreceptors
Mechanoreceptors
Metaboreceptors
Motor cortex

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The corollary discharge is sent from

a. sensory cortex
b. motor cortex
c. ventilatory muscles
d. Mechanoreceptors

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2 factors leading to dyspnea intensity

Dyspnea affective component

Dyspnea quality and unpleasantness

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Breathing is controlled by the respiratory center located in the

a. brainstem
b. pons
c. medulla

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The following statement is true

a. The respiratory center in the pons control breathing
b. Dyspnea is a result of cortical stimulation
c. the respiratory center is stimulated by abnormalities in blood gases as detected by lung mechanoerceptors
d. AOTA

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Disorders of the ventilatory pump include

a. increased airway resistance or stiffness
b. decreased compliance
c. J receptors
d. A and B
e. B and C

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______ is Increased neural output by the motor cortex sent to the sensory cortex

corollary discharge

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Location of sensory afferents involved in dyspnea

carotid bodies

medulla

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carotid bodies and medulla are activated by (3)

hypoxemia
acute hypercapnia
acidemia

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location of mechanoreceptors involved in dyspnea

Lungs

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lung mechanoreceptors are stimulated by

bronchospasm, sensation of chest tightness

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These recpetors are sensitive to interstitial edema, are activated by acute changes in pumonary artery pressure, and contribute to air hunger

J receptors and pulmonary vascular receptors

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Location of metaboreceptors involved in dyspnea

skeletal muscle

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3 parameters in assessment of dyspnea

quality of sensation
sensory intensity
baseline dyspnea index

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chest tightness or constriction EXCPET

a. Asthma
b. CHF
c. COPD
d. NOTA

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Increased work or effort of breathing EXCEPT

a. CPD
b. asthma
c. neuromuscular disease
d. chest wall disease
e. NOTA

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Air hunger, need to breath urge to breathe

a. asthma
b. COPD
c. PE
d. pulmonary fibrosis
e. neuromuscular disease

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Air hunger, need to breath urge to breathe

a. asthma
b. COPD
c. CHF
d. AOTA

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Inability to get a deep breath, unsatisfying breath

a. CHF
b. PE
c. chest wall disease
d. AOTA
e. NOTA

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Heavy breathing, rapid breathing, breathing more can be found in a. sedentary status in healthy individual b. patient with cardiopulmonary disease c. both d. neither

Modified borg scale is used in a. quality of sensation b. sensory intensity c. affective dimension

Chronic respiratory disease questionnaire are used as a methods which indirectly assess dyspnea due to other factors that limit it

Baseline Dyspnea Index

Evokes a stronger affective response then does increased work of breathing

Air hunger

What are the most common obstructive lung diseases

asthma and COPD

True of dyspnea caused by diseases of the airways EXCEPT a. Asthma and COPD are characterized by expiratory airflow obstruction b. leads to hypoxemia and hypocapnia c. Asthma and COPD causes hyperinflation of lungs and chest wall d. NOTA

B; hypercapnia

Cause of hypoxemia and hypercapnia in asthma and COPD

V/Q mismatch

more common as a consequnce of the different ways in which oxygen and carbon dioxide bind to hemoglobin a. hypoxemia b. hypoxia c. hypercapnia d. hypocapnia

Stiffen the chest wall a. COPD b. Kyphoscoliosis c. Myasthenia gravis d. Guillain-Barre Syndrome

``` Weaken ventilatory muscles A. Myasthenia gravis B. Guillain-Barre C. both D. Neither ```

interstitial lung disease is associated to a. increased stiffness b. increased work of breathing c. both d. neither

Effect of coronary artery disease and nonischemic cardiomyopathies effect on left ventricular end- diastolic volume a. Increase b. Decrease

Effect of coronary artery disease and nonischemic cardiomyopathies effect on left ventricular end diastolic pulmonary capillary pressures a. Increase b. Decrease

Effect of coronary artery disease and nonischemic cardiomyopathies effect on pulmonary capillar pressures a. Increase b. Decrease

Diastolic dysfunction is shown by LV a. stiffness b. dilation c. hypertrophy d. NOTA

Diastolic dysfunction show by stiff LV may lead to severe dyspnea with relatively mild degrees of physical activity particularly if it is associated with:

Mitral Regurgitation

Pulmonary thromboembolic disease and primary diseases of pumonary circulation cause dyspnea via the ff EXCEPT a. increased pulmonary-artery pressure b. stimulation of pulmonary receptors c. increased LV end diastolic pressure d. A and B e. B and C

T/F hyperventilation is common in diseases of pulmonary vasculature

Diseases of the pericardium causing dyspnea

Constrictive pericarditis and cardiac tamponade

Associated with increased pulmonary vascular pressure: a. constrictive pericarditis b. coronary artery disease c. both d. neither

these will be activated if cardiac output is compromised with lactic acidosis

metaboreceptors | chemoreceptors

Mild to moderate anemia are associated with breathing discomfort during exercise. This is most likely due to a. Mechanoreceptors b. Metaboreceptors c. both d. neither

B; lactic acidosis during exercise is detected by metaboreceptors in the skeletal muscles. Why not chemoreceptors? chemoreceptors are those in the carotid and medulla

Mechanisms of breathlessness in Obesity

high cardiac output | impaired ventilatory pump function

True of COPD EXCEPT a. increased work of breathing b. increased drive to breathe c. hypoxemia d. acute hypercapnia

True of COPD a. acute hypercapnia b. stimulation of pumonary receptors c. stimulaton of vascular receptors d. metaboreceptors

True about asthma except a. increased work of breathing b. stimulation of vascularreceptors c. increased drive to breathe d. hypoxemia

True about Asthma EXCEPT a. hypoxemia b. acute hypercapnia c. stimulation of pulmonary receptors d. metaboreceptors

True about Interstitial lung disease except a. Increased work of breathing b. incrreased drive to breathe c. hypoxemia d. acute hypercapnia e. AOTA

``` True about interstitial lung disease A. stimulation of vascular receptors B. Metaboreceptors C. Stimulation of Pulmonary Receptors D. AOTA ```

True of pulmonary vascular disease EXCEPT a. Increased drive to breathe b. hypoxemia c. acute hypercapnia d. stimulation of vascular receptors

C | ito lang 3 ang meron siya

True of deconditioning a. Acute hypercapnia b. hypoxemia c. metaboreceptros d. increased dirve to breathe

C ito lang

True of anemia a. hypoxemia b. acute hypercapnia c. stimulation of pulmonary receptors d. metaboreceptors

D ito lang

Cardiogenic pulmonary edema EXCEPT a. acute hypercapnia b. stimulation of pulmonary receptors c. metaboreceptros d. hypoxemia

C and increased work of breathing ang wala sa kanya

not present in Noncardiogenic pulmonary edema a. acute hypercapnia b. stimulation of vascular receptors c. both d. neither

C; and ito lang

difference of cardiogenic and non-cardiogenic pulmonary edema a. acute hypercapnia present only in cardiogenic b. stimulation of vascular receptors present in cardiogenic but not in non-cardiogenic c. both d. neither

dyspnea in the upright position

platypnea

platypnea can be found in (2)

left atrial myxoma | hepatopulmonary symptom

Orthopnea can be found in (3)

-CHF -mechanical impairment of the -diaphragm from obesity asthma due to GERD

Nocturnal dyspnea suggest

CHF | Asthma

Acute intermittent episodes of dypnea sugest

Myocardial ischemia bronchospasm Pulmonary embolism

Chronic persistent dysnpea seen in

-COPD -interstitial lung disease chronic thromboembolic -disease

- supraclavicular retractions - use of accessory muscles - tripod position are all evidence of

increased work of breathing

Increased work of breathing is indicative of

increased airway resistance/stiffness of the lungs and chest wall

systolic pressure decreases by >10mmHg

pulsus paradoxus

pulsus paradoxus is seen in (3)

COPD acute asthma pericardial disease

``` Chest percussion: dullness is indicative of the ff except a. pleural effusion b. mass c. hemothorax d. pneumothorax ```

Hyperresonance of the chest on percussion is a. normal b. sign of emphysema

When do you hear rales?

Interstitial edema/ fibrosis

Signs of elevated right heart pressure (3)

jugular venous distension edema accentuated pulmonic component of S2

LV dysfunction is observed in which heart sounds?

S3 and S4

Give a sign of diaphragmatic weakness

Paradoxical movement of the abdomen

Rounding of the abdomen during exhalation suggest

pulmonary edema

clubbing of the digits is an indication of

pulmonary fibrosis

Do you see clubbing in COPD?

Yes

Collagen vascular disease that can be associated with pulmonary mx

Raynaud's disease

Hyperinflation of lung is due to

obstructive lung disease

what is common in interstitial edema or fibrosis, diaphragmatic dysfunction or impaired chest wall motion

low lung volume

in the CXR,prominent pulmonary vasculature in the upper zone indicate

pulmonary venous hypertension

CXR: enlarged pulmonary artery suggest

Pulmonary arterial hypertension

CXR: Enlarged cardiac silhouette suggest

dilated cardiomyopathy or valvular disease

Bilateral pleural effusion on CXR suggest

CHF | collagen vascular disease

Unilateral pleural effusion on CX suggest

malignancy pulmonary embolism heart failure

intermittent symptom of astma and normal PE and lung function

Bronchoprovocation

assess CHF in acute dyspnea but can also be elevated in the presence of right ventricular stain

BNP

Favors cardiac cause of dyspnea EXCEPT a. heart rate is >85% of predicted maximum b. bp becomes excessively high or decreases during exercise c. ischemic changes seen on ECG d. patient achieves predicted max ventilation but had an increase in dead space

True of treatment of dyspnea EXCEPT a. goal is to correct underlying problem and lessen the intensity of the symptoms b. supplemental oxygen if saturation is <90% c. pulmonary rehabilitation d. no benefit for anxiolytics and antidepressants

B. <89%

CMD - Dyspnea Flashcards

(91 cards)