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Final Flashcards

1
Q

Define Kyphosis

A

Posterior angulation of thoracic cage

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2
Q

Define Kyphoscoliosis

A

Kyphosis and scoliosis together

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3
Q

Define scoliosis

A

Lateral curvature of the spine

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4
Q

A cough that comes from croup sounds like what

A

(barking/seal cough)Croup sounds like stridor. High pitched and monophonic

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5
Q

Symptoms of epiglottitis

A

Most common cause is H. influenza B infection. Symptoms may include high fever, sore throat, and difficulty breathing.

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6
Q

Risk factors of bronchiolitis

A 
Aka rsv (respiratory synical virus) 
•Being around cigarette smoke, age younger than 6 months, living in a crowded conditions, not being breast feed, prematurity (before 37 weeks gestation)
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7
Q

What type of lung cancer is most commonly treated with chemotherapy

A

Chemotherapy is the modality of choice for small cell lung cancer or advanced non-small cell cancer.

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8
Q

What size wheal determines a positive tb test in normal people?

A

15mm or more - Normal people
10mm - Intravenous drug users, residents of long term facilities
5mm or more- persons with known or suspected HIV infections

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9
Q

Lung cancer risk factors include

A
  • Smoking
  • Obesity
  • Genetics
  • Occupation
  • Diet
  • COPD
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10
Q

A clinical feature that would indicate a patient had CHF instead of ARDS would be a pulmonary capillary wedge pressure of _____ mm Hg

A

CHF- 18 or greater

ARDS- Normal ( around 15)

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11
Q

Hydrostatic pulmonary edema is also known as _______ pulmonary edema

A

Cardiogenic edema

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12
Q

To prevent disseminated intravascular coagulation and pulmonary embolism (DIC), what type of therapy would you use?

A
  • Physical Therapy
  • D-dimer test- is a small protein fragment found in the blood when fibrin clots are dissolving unless significant clotting has occurred in the body the test is normal if less than 200
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13
Q

What are the symptoms of inhalation injury?

A

•Cough, dyspnea, tahcypnea, cyanosis, wheezing, crackles, and rhonchi
-Smoke inhalation causes 50-90% of deaths in burn victims.

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14
Q

What is used to improve chest wall elasticity and relieve the compressive effect of burned skin

A

Escharotomy. Lateral incisions in the anterior axillary line extending from 2cm below the clavicle to the 9th or 10th rib and transverse incision across the chest (makes a square)

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15
Q

Define pulmonary abscess

A

Localized area of liquated necrosis of the lungs. The term lung abscess is usually reserved for necrotizing anaerobic pneumonia.

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16
Q

Name the morphological characteristics of bronchiectasis

A

Cylindrical- Mildest form with only slight widening of respiratory passages airway wall regularly and uniformly dilated
Varicose- Irregular pattern with alternating areas of constriction and dilation
Cystic- Progressive, distal enlargement of the airways, resulting in saclike dilations. Is the most severe and involves ballooning.

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17
Q

What is the important blood test in assessing a patient for DVT

A

D-dimer ELISA (enzyme linked immunosorbent assay) a negative result on a ELISA is a diagnostically useful as a lung scan or duplex ultrasonography finding.

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18
Q

What test will the doctor order to check whether patient needs to increase or decrease the dosage of Coumadin?

A

-INR
PT (prothombrine time) seconds required by plasma to form a fibrin clot after exposure to tissue factor
PTT (partial thromboplastin time) assesses the intrinsic coagulation pathway used to evaluate abnormalities in the blood.

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19
Q

What is the IPAH prognosis?

A

(idiopathic pulmonary arterial hypertension) AKA primary pulmonary hypertension. Uncurable disease and treatments given are only to make patients comfortable. Most children die within 1-2 years and adults within 2-5 years. Its also common for them to die due to infection due to frequent central line replacements

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20
Q

What is the normal pulmonary artery pressure?

A

The systolic pressure (normal, 15 to 30 mm Hg) and diastolic pressure (normal, 5 to 15mm Hg).

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21
Q

What type of patient is at greatest risk for atelectasis?

A

Patients with spinal cord injury and patient that are bedridden or recovering from major trauma are particularly predisposed to atelectasis secondary to lack of mobility.

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22
Q

What does persistent breathing at small tidal volumes cause?

A

Passive Atelectasis (Compression atelectasis (pg 946))

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23
Q

What occurs when mucus plugs are present in the airways and block ventilation?

A

Pathologic V/Q mismatch ( reabsorption atelectasis )

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24
Q

What are the signs and symptoms of TB?

A
  • Fatigue
  • low grade fever
  • night sweats and chills
  • Chronic cough
  • sputum production that test positive for acid fast bacilli
  • hemoptysis
  • Pleuritic chest pain
  • weight loss
  • Impaired resonance to percussion
  • bronchial breath sounds
  • Course crackles (dull percussion)
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25
Q

M. tuberculosis is transmitted by?

A

Acquired by inhalation of airborne droplets containing the microorganism and is deposited into the terminal airways and incite a host immune response. Ingestion of unpasteurized milk infected with the pathogen, directs inoculation of the skin, inhalation of fluid from contaminated materials (ie urine, sinus drainage, feces, sputum)

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26
Q

What is the most frequently cultured pathogen in community-acquired pneumonia?

A

S. pneumonia AKA pneumococcus accounting for 20-75% of cases

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27
Q

What is an abnormal amount of pleural fluid in the pleural space is called?

A

Pleural effusion

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28
Q

Define exudative and transudative. Which is more prominent?

A

Exudative-Caused by inflammation in the lung or pleura. Has more protein and inflammatory cells. Blocked blood vessels, inflammation, lung injury, drug reaction. Accounts for 70% of pleural effusions
Transudative- Forms when the integrity of the pleural space is undamaged. Increased pressure or low protein count in blood vessels. CHF most common cause. Less than 50% protein in the serum fluid.

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29
Q

What is the most common cause of clinical pleural effusions?

A

CHF

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30
Q

What is the normal apnea-hypopnea index?

A

Normal=less than 5
Mild= 5-15
Moderate= 15-30
Severe= greater than 30

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31
Q

How does CPAP improve breathing in the patient with OSA?

A

Pneumatic splinting of the upper airway

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32
Q

What is the primary cause of obstructive sleep apnea?

A

Small or unstable pharyngeal airway

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33
Q

Describe a patient and their attributes/symptoms of OSA

A
  • Excessive daytime sleepiness

- Large tonsils

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34
Q

What are the ABG results for respiratory failure?

A

From PPT:: Refer back to Respiratory Failure Powerpoint
•Respiratory Failure is divided into three categories. These are:
1.Acute hypoxemic respiratory failure (Type I)
2.Acute hypercapnic respiratory failure (Type II)
3.Chronic hypercapnic respiratory failure (Type I and Type II)
•Generally, failure is marked by a PaCO2 greater than 50 mm Hg and/or a PaO2 less than 60 mm Hg in the otherwise healthy individual breathing room air at sea level.
•Give an example of a hypoxemic respiratory failure ABG
pH- 7.55 PaCO2- 25 PaO2- 55 HCO3- 22 88%
pH- 7.48 PaCO2- 30 PaO2- 45
•Hypercapnic respiratory failure ABG:
pH of 7.24, a PCO2 of 60 mm Hg, and a PaO2 of 60 mm Hg
•Chronic hypercapnic respiratory failure ABG:
pH 7.39, PaC02 55, Pa02 48, HC03 is 38 and Sa02 is 88%.
Acute respiratory failure is identified by a PaCO2 >50 mm Hg and/ or a PaO2 <60 mm Hg in otherwise healthy individuals at sea level.
Hypoxemic respiratory failure is usually due to V/Q mismatch or intrapulmonary shunt.
Hypercapnic respiratory failure results from inadequate ventilatory drive, respiratory muscle fatigue, or excessive work of breathing.

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35
Q

Aspiration of the salt water causes?

A

Aspiration of the salt water causes fluid from the blood to flood into the alveoli

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36
Q

In wet drowning, as fluid enters the alveoli, the pathophysiologic processes are?

A

Noncardiogenic pulmonary edema

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37
Q

Failure of the cardiopulmonary system to provide and maintain adequate oxygenation for the blood is?

A

Respiratory Failure

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38
Q

Define fresh water drowning and what does it cause?

A
  • Is hypotonic to the blood and is rapidly absorbed into the blood stream when aspirated
  • It destroys pulmonary surfactant, thereby increasing surface tension properties within the lung, which results in atelectasis.
  • Small quantities of aspirated fresh water are absorbed in the pulmonary capillaries and no significant effect is noted.
  • When large quantities of the water are aspirated, the fluid being hypotonic is absorbed by the pulmonary blood and this causes an increase in the plasma volume.
  • Hypervolemia causes increased left ventricular work and promotes congestive heart failure.
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39
Q

Person suffers from sleepiness at inappropriate times, what is the cause?

A

Sleep Apnea

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40
Q

Which type of lung cancer has the fastest growth (doubling) rate?

A

Small Cell Carcinoma

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41
Q

What Therapy has been shown to reduce the incidence of bronchiectatic exacerbations in the patient with cystic fibrosis?

A

Inhaled tobramycin

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42
Q

What Therapy has been shown to reduce the rate of loss of lung function in patients with cystic fibrosis?

A

High doses of ibuprofen

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43
Q

What test is commonly used to confirm the diagnosis of cystic fibrosis?

A

Sweat chloride test

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44
Q

What test value confirms the diagnosis of cystic fibrosis?

A

•In children a sweat chloride concentration greater than 60 mEq/liter is consistent with the diagnosis of cystic fibrosis and 80 mEq/liter in adults.

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45
Q

What test used to determine if the patient is infected with the HIV virus?

A

•Elisa and a more accurate and expensive test known as the Western blot test

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46
Q

What is the hallmark symptom of bronchiectasis?

A

•Large amounts of purulent sputum

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47
Q

What is the ominous sign of a severe asthma attack?

A

•Episodic wheezing, shortness of breath, chest tightness, and cough

48
Q

Define Amyotrophic lateral sclerosis

A

loss of motor neurons in the anterior horn of the spinal cord. Degeneration of the upper and lower motor neurons. May cause asymmetric weakness, atrophy, and tremors. Patients have difficulty breathing, swallowing, and talking. Respiratory failure and death occurs 3-4 years after the onset of the symptoms.

49
Q

Define Guillain-Barre Syndrome

A
  • known as acute postinfectious polyneuropathy and is frequently preceded by a viral-type illness.
  • Most common neuropathy causing respiratory insufficiency
  • Initial symptoms often include weakness of the lower extremities and paresthesia (sensations of numbness or tingling) in the toes and fingers
  • The lower extremity weakness is usually symmetrical, and the weakness progresses to the muscles of the abdomen, diaphragm, arms, and face.
  • The patient may experience difficulty swallowing and poor gag reflex as the muscles of the throat become involved
50
Q

Define Myasthenia Gravis

A

Characterized by intermittent muscle weakness which worsens on repetitive stimulation. An immunologic disease resulting from circulating antibodies directed against acetycholine receptors in the junction

51
Q

Define Muscular dystrophy

A

(a myopathy)Muscular dystrophy (MD) refers to a group of genetic diseases characterized by progressive weakness and degeneration of the skeletal or voluntary muscles which control movement.
-Duchenne is the most common form of MD affecting children, and myotonic MD is the most common form affecting adults.

52
Q

Describe pulmonary rehabilitation-goals, expectations, outcomes, etc

A
  • Control of respiratory infections
  • Basic airway management
  • Improvement in ventilation and cardiac status
  • Improvement in ambulation and other types of physical activity
  • Reduction in overall medication cost
  • Reduction in hospitalizations
  • Psychosocial support
  • Occupational retraining and placement
  • Family education, counseling, and support
  • Patient education, counseling, and support
  • Control of respiratory infections
53
Q

What medications are used for asthma

A

Corticosteroids

54
Q

Define blue bloater

A

•Chronic bronchitis caused by excessive mucus production

55
Q

What is used to measure the severity of thoracic cage?

A

•Cobb angles are used to measure the severity in which disorder of the thoracic cage

56
Q

Explain what the Tensilon test, what is it used to measure.

A

Tensiolon (edrophonium) is given intravenously then the patient is asked to perform a series of muscle movements over and over. The health care provider determines whether tensilon improves patients muscle function. This test helps determine if the patient has myasthenia gravis or a different disease

57
Q

Explain how to determine if the patient is suffering a cholinergic or myasthenic crisis.

A
  • The patient is suffering from myasthenic crisis when excess fatigue leads to failure
  • Cholinergic crisis mimics myasthenic crisis when excess use of anticholinesterase therapy leads to failure
58
Q

Define Multiple Sclerosis

A

One of the most common diseases of the central nervous system. Caused by a damage of the myelin sheath surrounding nerve fibers. More likely in women than men. Symptoms include:

  • blurred vision
  • Weak limbs
  • tingling sensations
  • unsteadiness and fatigue
59
Q

Define Ankylosing spondylitis

A

Chronic inflammatory disease of unknown origin, first affecting the spine and adjacent structures commonly leading to eventual fusion (ankylosis) of the joints.

60
Q

Define Lambert-Eaton Syndrome

A

More than 50% are associated with cancer and of the 50, 80% are associated with small cell carcinoma. Leads to muscle weakness frequently with sensory deficits that can often be improved by repetitive muscle contraction against pressure.

61
Q

Define Croup

A

Croup is breathing difficulty and a “barking” cough also known as stridor. Croup is due to swelling around the vocal cords. It is common in infants and children.

62
Q

Define Epiglottitis

A

Acute, often life-threatening infection of the upper airway, which causes severe obstruction secondary to supraglottic swelling: caused primarily by Hemophilus influenza type B and affecting mainly children younger than 5 years old.

63
Q

Define Bronchiolitis

A

Bronchiolitis is swelling and mucus buildup in the smallest air passages in the lungs (bronchioles), usually due to a viral infection. Bronchiolitis usually affects children under the age of 2, with a peak age of 3 - 6 months. It is a common and sometimes severe illness. Respiratory syncytial virus (RSV) is the most common cause. More than half of all infants are exposed to this virus by their first birthday.

64
Q

Define OSA

A

condition in which five or more apneic periods (lasting atleast 10 seconds) occur per hour of sleep and characterized by occlusion of the oropharyngeal airway with continued efforts to breathe.

65
Q

Define Central sleep apnea

A

absence of breathing as the result of medullary depression that inhibits respiratory movement, which becomes more pronounced during sleep.

66
Q

Define Mixed sleep apnea

A

or complex sleep apnea, is a combination of central and obstructive.
*** Central comprises .4%; obstructive comprises 84%, and complex comprises 15 % of cases reported.

67
Q

What are you assessing when you do parameters on your neuromuscular patients?

A

Assesses the strength of the diaphragm which in turn assess their lung function.

68
Q

What causes IPAH?

A

IPAH is unexplained and only diagnosed when all other forms of hypertension have been ruled out.
-It occurs when the mean pulmonary artery pressure rises above 25 mm Hg at rest with a normal capillary wedge and can eventually lead to right ventricular failure

69
Q

List the chain of events that occur with pulmonary fibrosis.

A 
Lung injury
Inflammation
Disordered Repair of Involved Tissue
Pulmonary Fibrosis
End-Stage Lung Disease
70
Q

Define PPH and its symptoms manifestations.

A

Primary pulmonary hypertension (PPH) is a rare disease characterized by elevated pulmonary artery pressure with no apparent cause. PPH is also termed precapillary pulmonary hypertension or, more recently, idiopathic pulmonary arterial hypertension (IPAH).
Symptoms include- Dyspnea, Angina pectoris, Syncope, Cyanosis, Peripheral edema, Pleural Edema, Hemoptysis (rare), Frequent cough (usually non-productive), Abdominal Swelling

71
Q

List complications of thoracentesis.

A

There are three major risks

  1. intercostal artery laceration
  2. infection
  3. pneumothorax
72
Q

What chest woundacts as a one-way valve?

A

Piercing chest wound may also result in a closed (valvular) or tension pneumothorax through a one-way valve-like action of the ruptured parietal pleura. ( tension pneumothorax)

73
Q

Where is the chest tube placement for pneumothorax and pleural effusion?

A

Pnuemothorax is between the 2nd and 3rd intercostal space and a Pleural effusion is placed lower and between the 5th and 6th intercostal.

74
Q

What are sleep apnea symptoms

A

loud snoring , restless sleep, frequent silences during sleep due to breaks in breathing, choking or gasping during sleep to get air into the lungs, sudden awakenings to restart breathing or waking up in a sweat, daytime sleepiness, morning headaches, depression, high blood pressure, decline in mental functioning

75
Q

Define hydrostatic pulmonary edema

A

Hydrostatic (cardiogenic) edema- is the result of increased venous hydrostatic pressure leading to fluid accumulation and alveolar flooding.

76
Q

Define non-hydrostatic pulmonary edema

A

Non-hydrostatic (non-cardiogenic) edema- is the result of loss of microvascular membrane integrity. It differs from hydrostatic because non hydrostatic is associated with increased total lung water despite normal microvascular hydrostatic pressure.

77
Q

What is used to diagnose IPAH?

A

A physical examination is used to detect the presence of pulmonary hypertension. These tests include PFTs, blood tests, ECG analysis, CXR, CT scans, V/Q scanning, Echocardiogram, pulmonary artery catheterization,and possibly a lung biopsy. If after each of these tests have been performed and no underlying cause is detected the diagnosis is Idiopathic pulmonary artery hypertension

78
Q

Define Pink puffer

A

Emphysema

79
Q

Define Aspergillus

A

Caused by a fungus (Aspergillus) which is commonly found growing on dead leaves, dust, stored grain, compost, piles, or in other decaying vegetation.

80
Q

Define H. capsulatum

A

Grows as a mold in the soil and infection results from inhalation of airborne fungal particles. Soil has been contaminated with bird or bat droppings and may have a high concentration of mold.

81
Q

Define Coccidioidomycosis

A

AKA Valley Fever. Inhalation of spores which is also found in desert regions.

82
Q

Define Cryptococcus

A

C. neoformans var neoformans comes from isolated from the soil world wide, usually associated with bird droppings. C. neoformans var gatti has been isolated from eucalyptus trees in the tropical and subtropical regions.

83
Q

Define Sporotrichosis

A

Mold spores are forced under the skin by rose thorns or sharp sticks, unbroken skin in contact with hay or moss carrying mold. Cats or armadillos can transmit the disease can be inhaled or ingested.

84
Q

Define Chronic bronchitis

A

Is defined in clinical terms as a condition in which chronic productive cough is present for at least 3 months per year for at least 2 consecutive years.

85
Q

Explain how to test for scoliosis

A

The degree of scoliosis is measured by cobb angles which is determined by the intersection of lines drawn between the upper and lower limbs of the primary curve in scoliosis. Respiratory insufficiency rarely occurs until the cobb angles exceed 90 to 100 degrees.

86
Q

Definition of sleep apnea uses what criteria for defining an episode of apnea?

A

Repeated episodes of complete cessation of airflow for 10 seconds or longer.

87
Q

Define parietal pleura

A

Thin membrane covering the surface of the chest wall, mediastinum, and diaphragm that is continuous with the visceral pleura around the lung hilum.

88
Q

Define visceral pleura

A

Thin membrane covered by mesothelial cells that covers the entire surface of the lung, dipping into the lobar fissures.

89
Q

Define thoracentesis

A

Surgical perforation of the chest wall and pleural space with a needle for diagnostic or therapeutic purposes of the removal of a specimen for biopsy.

90
Q

Define tension pneumothorax

A

Air in the pleural space that exceeds atmospheric pressure causing outward expansion of the ribs, downward depression of the diaphragm, mediastinal shift, and hypotension.

91
Q

Define secondary spontaneous pneumothorax

A

Pneumothorax that occurs because of underlying lung disease.

92
Q

Define pleurodesis

A

Procedure of fusing the parietal and visceral pleura to prevent formation of pleural fluid or recurrence of pneumothorax.

93
Q

Define reexpansion pulmonary edema

A

Rapid reexpansion of a chronically collapsed lung.

94
Q

Define hemothorax

A

Presence of blood in the pleural space

95
Q

Define pleural effusion

A

Abnormal collection of fluid in the pleural space.

96
Q

Define pleurisy

A

Pain that comes from the pleural surface; usually a direct result of viral infections but has been generalized to any condition (eg pulmonary embolism) causing pleural pain.

97
Q

Define pneumothorax

A

Presence of air or gas in the pleural space of the thorax; if this air or gas is trapped under pressure, tension pneumothorax exists.

98
Q

Define primary spontaneous pneumothorax

A

A pneumothorax that occurs without having an underlying lung disease.

99
Q

What are Most effective medications commercially available for asthmatics?

A

Corticosteroids

100
Q

Name the PEF zones

A

Green= 80-100% of the personal best
-Take medication as normal
Yellow=50-80% of personal best
-Take albuterol wait 20 min try again if still low take albuterol again wait 20 min try again if still in the yellow call the physician
Red= less than 50% of personal best
-Take albuterol and get to a physician

101
Q

Streptokinase is used to treat

A

Used to dissolve blood clots. Used immediately after symptoms of an MI. Treats PE and DVT

102
Q

•Which of the following conditions is most closely associated with exudative pleural effusion?

A

Tuberculosis

103
Q

•Overlap syndrome is a condition in which obstructive sleep apnea and _____ coexist in the same patient.

A

COPD

104
Q 
•Which of the following factors has been shown to positively correlate with obstructive sleep apnea?
A. blood pressure at rest
B. height
C. obesity of the upper body
D. age
A

C. obesity of the upper body

105
Q 
Which of the following results from acute asphyxia thought to be caused laryngospasm or prolonged breath holding. Death without aspiration
A.) Near drowning
B.) Dry drowning
C.) Wet drowning 
D.) Immersion syndrome
A

B.) Dry drowning

106
Q

What may be the drug of choice for managing atopic asthma in children?

A

Cromolyn

107
Q

Which bronchodilator is commonly used in the hospital management of acute asthma exacerbation but is not the first-line bronchodilator?

A

Atrovent

108
Q

What medication would likely be the least often ordered during the emergency department management of an acute asthma attack?

A

methylxanthines

109
Q

•Central sleep apnea occurs more often than obstructive sleep apnea.
TRUE OR FALSE

A

FALSE

110
Q

•Which of the following conditions are associated with central apnea?
I.congestive heart failure
II.primary central nervous system lesions
III.high-altitude hypoxemia
IV.obesity

A

I, II, and III

111
Q

In myasthenia gravis, which two pulmonary function values are the most sensitive in detecting respiratory muscle weakness?

A

PImax and PEmax

112
Q

When using a small-bore catheter with a one-way valve such as a Heimlich valve, how can you determine definitively that there is or is not a small air leak?

A

Connect to an underwater seal

113
Q

Chest tubes should be directed toward the base of the lung to evacuate a pneumothorax.
TRUE OR FALSE

A

FALSE

114
Q

At what anatomic position should an 18-gauge IV catheter be placed to relieve a tension pneumothorax?

A

just inferior to the second rib

115
Q

For which type of pneumothorax is pleurodesis most commonly indicated?

A

Spontaneous

116
Q

What agent has proved to be the most successful in pleurodesis?

A

•talc suspended in saline

117
Q

A patient with pulmonary emboli has severe hypoxemia, acute right-sided heart failure, and shock. What treatment should be given at this time?

A

streptokinase

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