Final Exam Flashcards
(35 cards)
In healthy individuals the respiratory central pattern generator and “drive to breathe” is regulated primarily by which blood gas concentration?
A.CO2 (Carbon Dioxide)
B.O2 (Oxygen)
C.N2 (Nitrogen)
D.HCO3 (Bicarbonate)
Are there situations where this might change?
CO2; COPD can change this since CO2 levels are higher and O2 and CO2 levels are off
Nitrogen stays in the lungs and acts as a filler to help them stay open
The muscles of inspiration work against which of the following forces?
A.Weight of the lungs
B.Airway resistance
C.Elastic recoil of the chest wall
D.Both B and C
Why is this important?
What are situations where these forces may change?
D. Both B and C; they have to resist against the recoil and whatever resistance is introduced to the airway but not the weight of themselves
Increased resistance can impact airflow (bronchorestriction); impaired diaphragm can have huge consequences
emphysema, and CF can both increase airway resistance
The thoracic wall/rib cage moves in what direction when the diaphragm contracts?
A.Superior, lateral and anterior
B.Superior, lateral and posterior
C.Inferior, lateral and anterior
D.Inferior, lateral and posterior
What about the abdomen?
Are there any conditions where this might be different?
B. Superior, lateral and posterior; decreases pressure and increased the thoracic cavity
the abdomen should expand outward as you inhale
Paradoxical movement can be seen in post polio patients and quadriplegics as well as severe COPD
Which of the following diseases is characterized by air trapping, increased residual volume, and a flattened diaphragm?
A.Asthma
B.Emphysema
C.Idiopathic Pulmonary Fibrosis
D.Cystic Fibrosis
Why do lung and chest volumes increase in patients with COPD?
B. Emphysema; pink puffers that decrease recoil with increased resistance
IPF is destruction of alveoli; impaired gas exchange
asthma is a hyperactive airway/bronchorestriction
CF is increased mucus production; defect in NaCl channels
Volumes increase in patients with COPD since they have a limited ability to expell air so lots of air stays trapped in lungs
What are some explanations for the functional limitations and impaired tolerance to activity in patients with COPD?
Uncomfortable for them to exercise; can’t handle the increase in respiratory rate; takes lots of energy to do less due to the metaboreflex
Which genetic disorder results in defects to Na+ and Cl-channels resulting excessive in salty mucous formation that causes multisystem disease?
A.Alpha trypsin-1 deficiency
B.Cystic Fibrosis
C.Asthma
D.Sarcoidosis
What type of condition is this disorder?
B. Cystic fibrosis; increased mucus production due to impaired NaCl channels
Septic Obstructive disorder
A lesion above which spinal cord level would require a patient with a spinal cord injury (SCI) to require mechanical ventilation?
A.C7
B.C3
C.C5
D.C6
B. C3
C3-5 keep you alive; not enough innervation for the diaphragm to work properly
Which of the following is an occupational cause of intrinsic restrictive lung disease?
A.Idiopathic Pulmonary Fibrosis (IPF)
B.Obesity
C.Asbestosis
D.Rheumatoid arthritis
C. Asbestosis; all others are acquired through lifestyle or genetic factors
Which areas of the lungs would you normally appreciate vesicular lung sounds?
A.Trachea
B.Parasternal borders
C.Peripheral
C. Peripheral - soft, low pitched rustling
Tracheal is loud, high pitched
Parasternal borders are bronchovesicular
Which segments are most likely to develop atelectasis following bed rest in a supine position?A.Apical
B.Middle Lobe and Lingula
C.Anterior upper
D.Posterior basal
What are some additional examinations or procedures to perform if crackles are observed?
D. Posterior basal since that is the way gravity will pull the mucus
Atelectasis is small airway collapse
additional examinations are vitals; take 10 full breaths per hour; frequently change positions; encourage to cough; incentive spirometry
You examine a patient in the ICU following CABGx3 who present with decreased breath sounds and crackles in bilateral posterior basal segments that resolve with coughing. Their respiratory rate is slightly elevated (24 breaths/min), Blood pressure (118/72mmHg) and HR (84bpm) are within normal limits. The patient is afebrile (37 deg C). What is the most likely cause of these findings?
A.Pulmonary Edema
B.Pulmonary Embolism
C.Post operative atelectasis
D.Pleural effusion
C. Post-operative atelectasis; resolves with coughing
PE would have a fever
Pulm Edema would not clear with a cough
Which of the following symptoms are not associated with a bacterial pneumonia (PNA)? A.Productive Cough
B.Dry/non productive cough
C.Abrupt onset
D.Segmental lung consolidations
What is lung consolidation?
B. Dry/non productive cough; these patients will have a productive cough; very abrupt onset
Lung consoldiation is when air in the lungs is replaced by something else - pus, blood, water, etc.
A 55-year-old male patient status post Right Total Knee Arthroplasty presents to the clinic. The patient is reporting dyspnea, sharp chest pain, tachycardia, and hemoptysis.
A.Pulmonary Edema
B.Pulmonary Embolism
C.Pleural Effusion
D.Post operative atelectasis
B. Pulmonary embolism; post-op patient coughing up blood
POA would not be painful
Pulm edema would have pink, frothy speutum
You are providing field coverage for a college rugby match and witness a player collapse to the ground grasping his left side after taking a hard blind-sided tackle. You rush onto the field to examine him. The patient is in distress however conscious and reports sharp 9/10 left-sided chest pain, worsening with inspiration. He is dyspneic and tachycardic with dropping blood pressure and trachea deviated to the right. His chest wall is extremely painful to palpation. On auscultation, you appreciate absent breath sounds in all of the left lung segments. What is the most likely diagnosis?
A.Pulmonary embolism
B.Tension Pneumothorax
C.Dislocated rib
D.Rib fracture
B. Tension pneumothorax; trauma induced
PE would not be a sudden onset and usually in post-op patients
Rib fx/dislocation would not cause that many symptoms in a patient
Which airway clearance technique would be the most appropriate for a patient who is independent with mobility, and coughing with increased pulmonary secretions due to bacterial pneumonia?
A.Active cycle of breathing
B.Manual Chest Percussion
C.High frequency mechanical Percussive Vest D.Manual Chest Vibration
A. ACB since they are able you want to do something more active than passive
Rule of 3s then cough
Which ventilatory/breathing technique is effective at improving tolerance to activity in patients with COPD?
A.Pursed Lip Breathing
B.Paced Breathing
C.Valsalva
D.Both A and B
Can this be used for other patients?
D. Both A and B; paced is more related to activities
Can also use this technique for patients with asthma
What would be the most effective breathing technique to reduce chest wall pain following median sternotomy?
A.Faciliatory/Segmental Breathing
B.Braced/Splinted Breathing
C.Active Cycle of Breathing
D.Deep Slow Breathing
B. Braced splinted breathing is the only once used specifically for pain
You receive a referral to evaluate a patient in the surgical intensive care unit status post right total hip replacement. This is postoperative day 1. The patient’s lab values are the following:
Hgb: 9.0 Hct: 30 WBC: 12,500 Platelets: 200,000 RBC: 4.4
Are these normal expected values?
What else would you want to check?
Hgb and Hct are low while WBC and Platelets are high but these values are normal and expected after having surgery due to blood loss and immune response.
Would want to go off of vitals, temperature, symptoms, and wound integrity to see if something is wrong instead of labs
Which of the following medications is a long-acting beta-2 agonist?
A.Albuterol (Ventolin)
B.Salmeterol (Serevent)
C.Tiotropium (Spiriva)
D.Fluticasone (Flovent)
B. Salmetrol is long acting
Albuteral is short acting, rescue
Titropium is an antagonist
Fluticasone is a glucosteroid inhaler
Which of the following drinks contain Methylxanthines?
A.Caffeinated coffee
B.Orange Juice
C.Tomato Juice
D.Water
A. Coffee! and chocolate can act as bronchodilators; inhibits PDE and cAMP
Patients with which diagnosis would benefit the most from a Leukotriene Inhibitor?
A.Asthma
B.Emphysema
C.Idiopathic Pulmonary Fibrosis
D.Sarcoidosis
A. Asthma; leukotrine inhibitor is an anti-inflammatory
Emphysema and IPF arm more for damage to the alveoli/air sacs
Which statement is true regarding smoking cessation?
A.Most smokers report that they want to quit
B.Lung function of smokers may improve by a considerable degree within a 1 week of cessation.
C. Difficulty quitting is best predicted by how much one smokes daily and if they begin smoking within 30 minutes of waking?
D.All of the above
D. All of the above
T or F: The evidence regarding the benefits of pulmonary rehabilitation is not observed in patients with IPF and is only observed in patients with COPD.
False, rehab for IPF is included in recommentations and is deemed integral and essential
Which of the following is a relevant clinical examination in a Pulmonary Rehabilitation setting? A.BEST Balance Test
B.Timed Up and Go
C.6 minute Walk Test
D.All of the above
D. All of the above - treat the impairments!
