Final Study Guide Flashcards
(124 cards)
1
Q
What value do we determine if a pt is obstructive
A
The FEV1/FVC ratio of 70% or less
2
Q
What will decrease with obstruction pt
A
Their FEV1/FVC and fev1 decreased
3
Q
What will restrictive pt see
A
Decreased FVC
4
Q
Is emphysema restrictive or obstructive
A
Obstructive
5
Q
Cardiogenic and non cerdiogenic pulmonary edema (restrictive or obstructive?)
A
Restrictive
6
Q
Chronic bronchitis ( restrictive or obstructive?)
A
Obstructive
7
Q
Atelectasis( restrictive or obstructive?)
A
Restrictive
8
Q
What is type 1 respiratory failure
A
Hypoxemic respiratory failure: problem is oxygenation (decreased pao2)
9
Q
What is type 2 respiratory failure
A
Hypercapnic respiratory failure: problem is alveolar hypoventilation ( increased co2 and decreased o2)
10
Q
What is acute on chronic ventilatory failure
A
Pt with pre existing chronic respiratory condition with acute respiratory failure ( increased o2 and decreased co2)
11
Q
What is a shunt
A
Non oxygenated blood avoids gas exchange / alveoli is unavailable
12
Q
What is deadspace
A
Amount of air in the lungs that don’t participate in gas exchange ( air that doesn’t get expired -stays forever)
13
Q
What treatment for pt with long term lung disease has been shown to improve long term survival and prevent them from developing right sided heart failure ( for pulmoale)
A
Diuretics and steroids
14
Q
What is cor pulmonale
A
Lung disease and right sided heart failure causing right ventricular enlargement ( not enough blood getting pumped)
15
Q
What happens to our pt pulmonary capillaries when they are hypoxic
A
Vasoconstriction? Inadequate o2 is going through ac membrane
16
Q
What chronic condition makes pt more susceptible to cor pulmonale
A
Chronic bronchitis, emphysema and pulmonary fibrosis
17
Q
What are 4 common symptoms associated with cor pulmonale
A
Dyspnea, JVD, pitting edema and chest pain
18
Q
Written 4 differences between left sided and right sided heart failure
A
Left side (CHF)- frothy pink and white sections with 3 Bs on cxr
Right sided heart failure- pitting and pedal edema and jugular venous distension
19
Q
What is found in red blood cell and carried o2 to tissues
A
Hemoglobin
20
Q
What does hypoxia mean
A
Lack of o2 in tissues
21
Q
What does hypoxemia mean
A
Lack of o2 in blood
22
Q
How to calculate P/F ratio
A
PaO2/Fio2
23
Q
Calculate total arterial oxygen content (CaO2)
A
(Hb x 1.34 x sao2) + ( 0.003 x pao2)
24
Q
Calculate anion gap
A
Na + k- ( cl + Hco3) or Na -( cl + hco3)
Normal is 8-16
25
Calculate Cvo2
(Hb x 1.34 x svo2) +( 0.003 x pvo2)
26
Calculate C(a-v) o2
CaO2 - CvO2
27
What does A-a gradient tell us
Measures difference of o2 pressure between the alveoli and arterial blood
28
What are the 4 types of hypoxia and what causes it
Hypoxemia : low pao2 and cardiac output ( caused by increased altitude, hypoventilation, v/q mismatch and pulmonary shunting
Circulatory ( stagnant): low blood pressure ( caused by hypotension, pooling of blood, arterial venous shunt and low cardiac output
Anemic: low hemoglobin ( caused by anemia, sickle cell, carboxyhemoglobin and methemoglobin
Histotoxic : cyanosis( caused by cyanide poisoning and increased lactic acid
29
*written* what is the significance of DO2 ( delivery of oxygen)
Measures how well oxygenated blood is delivered to the tissues
C.O x cao2 x 10
30
What would increase vocal fremitus
Atelectasis, pulm edema, lung tumor, pulm fibrosis and thin chest wall
31
How can we assess a pt hemodynamic status non invasive
Blood pressure and pulse ox
32
What is something the RT can collect to help identify the cause of pneumonia
Sputum culture and sensitivity and wbc
33
Most common manifestation of infection in a pt with pulm disease
Pseudomonas aeruginosa
34
Most common cause of CAP community acquired pneumonia
Streptococcus pneumoniae
35
What is the best time of day to obtain a sputum sample
Morning
36
What can predispose a pt to aspiration pneumonia
GERD, asthma, dysphasia, developing ARDS, aspiration in pregnancy and trach pt
37
How is TB transmitted
Through aerosol droplets by laughing talking and coughing. Droplets are aerobic ( needs o2)
38
How long does TB treatment last
6-9 months
39
* written* what is one of the biggest challenges in treating pt with TB
Patient compliance
40
What type of sputum test is indicated for pt with suspected TB
Sputum culture and acid fast stain
41
Before the pt is taken out of TB isolation they must have
3 sputum acid fast smears that are negative for 3 days
42
What would we see in sputum of an asthmatic
Charcot Leiden crystal, curschmanns spirals and esosinophils
43
An asthmatic has a PEFR of 48% what is indicated next
Seek medical attention
44
Examples of lama
Tiotropium, spiriva and ellipta
45
Examples of Saba
Xopenex, albuterol
46
What is pulsus paradoxus
Drop in systolic pressure if more than 10 mmHg during inhalation
47
Examples of instrinsic non allergic asthma (inside)
Stress and gerd
48
Example of extrinsic allergic asthma ( outside)
Dust mite, animal dander, cockroach poop, pollen and mold
49
The presence of any of these signs and symptoms should indicate the suspicion of asthma
Wheezing, chest tightness, difficulty breathing and coughing
50
What does national asthma education project recommend be measured at home in pt with moderate to severe asthma
, PEFR
51
What tests can be done in the PFT lab to diagnose asthma in pt with sporadic symptoms
FENO skin test, RAST and bronchial provocation test with methacholine
52
Describe late life onset asthma
Asthma developed during adult life, more common is women during pregnancy or menopause
53
What is often associated with paroxysmal nocturnal dyspnea( PND)
CHF
54
* Written* Define cheyne strokes
When pt is hyperventilation followed by apneic episode then continue hyperventilating
55
Why do pt with CHF tent to have orthopnia
When laying supine the fluid is retains in the back and lungs
56
What causes cardiogenic pulmonary edema
CHF( common), increased hydrostatic pressure and hypertension
57
What treatment modalities are for cardiogenic pulm edema
CPAP, lung expansion, o2, and 3D’s( digitalis, diuretics and dopamine)
58
What does cardiogenic pulmonary edema appear on PFT
Restrictive
59
What’s normal hydrostatic pressure in pulm edema
10-15 push out
60
Normal osmotic pressure in pulmonary capillaries
25-30 pulls fluid in
61
Radiographic signs of non cardiogenic pulmonary edema
Increase opacity( white) ground glass and messy
62
Treatment for cardiogenic pulm edema pt in distress
CPAP and aerosol med , diuretics and lung expansion with o2
63
Radiologic finding for pt with cardiogenic pulm edema
3 Bs ( bat wings, kerly B and big heart
64
Most common cause of cardiogenic pulm edema
Left sided heart failure ( CHF) - hydroststic pressure increased
65
Types of secretions most common in pt with cardiogenic pulm edema
Frothy white or pink secretions
66
Movement of fluid in and out of capillaries is expressed by what equation
Starling equilibrium
67
Common respiratory pattern seen in pt with left sided heart failure
Cheyne strokes
68
What treatment modality is most beneficial for pt with cardiogenic pulm edema
CPAP, double D( digitalis and diuretic
69
What medications are helpful for pt who are in CHf exacerbation
Diuretics digoxin and ace inhibitors
70
What is BNP and what are the values s
It reflects heart function ( normal <100)
Used to diagnose CHF
Increased heart rate = increased BNP= CHF (100-900 severe)
71
Cardiogenic x ray
3Bs ( big heart, bat wings and kerly B)
Pleural effusion and fluffy edema
72
Non cardiogenic x ray
Increased opacity( white)
Ground glass
Very messy
73
Define pulmonary infarction
Tissue in the lungs die due to blocked pulmonary artery
74
A pulmonary embolism causes which of the following major pathological chance in lungs
Atelectasis, bronchospasm, cor pulmonale, blocked pulm vascular, consolidation and pulm infarction
75
What could pre dispose a pt to having a pulm embolism
Prolonged bed rest, trauma, pregnancy and hyper coagulation disorder
76
Best test for diagnosing a pulm embolism
CTPA
77
What are components of virchows triad
Venous stasis( low blood flow
Hyper coagulation ( high rush of blood clot)
Injured endothelial cell
78
What is saddle embolus and why its fatal
Embolism passes through right heart and stays in the bifurcation of pulm artery
Fatal bc embolism blocks flow and prevents blood from passing through both arteries
79
How to prevent DVT
Walking, hydration, compressive stockings and thigh high cuffs
80
Pulm embolism is an example of dead space or shunt
Dead space
81
When should we intubate/ventilate a pt with neuromuscular disorder? What would happen to their MIP, tidal volume and vital capacity
Intubate if MIP <-20, VT <5 and VC<10 ml/kg
82
Different clinical features between MG and GB neuromuscular disorders
MG- Ascending : ptosis, diplopia, and neck weakness
BG- Descending: muscle weakness in lower extremities
83
What happens when a MG pt uses their muscles repeatedly
They get more weak
84
What happens when a MG patient rests
They get more energy
85
Which demographic are most likely to develope MG
Makes 40-70 yrs and women 15-35
86
What test is usually performed to confirm the diagnosis of myasthenia gravis
Endeophonium ( tension ) test
87
What are we monitoring our pt with neuromuscular disease for
Respiratory failure
88
What type of test is performed to confirm GB diagnosis
Spinal tap
89
What would spinal tap test show
Increased protein levels ( 100-1000) with normal WBC
90
What happens that causes muscle weakness in pt with GB
Immune response to viral or bacterial infection which attacks nerve tissues and affect peripheral motor and sensory neurons
91
What could predispose someone to a primary spontaneous pneumothorax
Talk thin and young white makes who smoke
92
Would could predispose someone to a secondary spontaneous pneumothorax
COPD, TB, pneumothorax and cystic fibrosis
93
Define flail chest
Multiple rib fractures at 3 or less ribs
94
How would a pneumothorax show on a PFT
Restrictive
95
What is a treatment used for pt with repeated pneumothoracies that causes inflammatory reaction so the pleural surface adheres to the inside of the chest wall?
Pleurisy
96
What can cause an iatrogenic pneumothorax
Thoracentesis, venous catheter and bronchoscopy
97
What is a possible second finding in a pt with flail chest
Contusion
98
Difference between primary and secondary spontaneous pneumothorax
Primary- rupture of pleural bleb affecting both lungs
Secondary- bullae suddenly burst
99
Treatment options for pt with pneumothorax
Bed rest, chest tube, and needle decompression
100
*written* describe paradoxical chest movements with flail chest
Broken ribs will move outwards during exhalation and move inwards during inhalation
101
* written* how does a pt breathe with flail chest and what does it predispose them to
Breathe with paradoxical chest movements and can lead to pulmonary contusion
102
Define near drowning
Water floods into lungs but pt survives
103
Define dry drowning
Glottis shuts closed and prevents water from entering
104
Define wet drowning
The glottis relaxes and allows water to enter the lungs
105
What happens to the bronchial wall after inhaling water
They constrict
106
What happens during drowning or near drowning ( sequence)
Panic/ struggle, calm/ apnea, swallowing fluid and vomiting, aspiration, level of consciousness/ coma, then death
107
Are burn pt considered trauma and what’s the main priority
Yes, always protect the airways
108
Upper airways improve during intermediate (2-5 days after. What will we see
Increased mucus production due to a decline in ciliary function
109
During the late stage ( 5 + days after) and smoke inhalation what will we see
Infection on wounds that can lead to sepsis and multi organ failure which causes death
110
What can be developed in the late stage of smoke inhalation
Pulmonary embolism can develop after 2 weeks due to DVT( deep vein thrombus)
111
What will we see in thermal injuries in the upper airway
Blistering, mucosal edema, vascular congestion, epithelial shedding, thick sections and upper airway obstruction
112
What are some carbon monoxide signs
Anxious, altered voice, headache, confusion, tachycardia, tachypnea, and cherry red skin
113
Signs and symptoms of burns
LOC, facial burns, singed nasal hairs, hoarseness and stridor ( intubate) ashes in nose and orophaynx
114
How many pulmonary disease are classified as ILD
180
115
ILD is restrictive or obstructive
Restrictive with low DLCO but it can be obstructive if bronchial inflammation and increased secretions develoo
116
Examples of inorganic exposure ( inedible)
Asbestosis, coal dust, silica, beryllium, aluminum, barium, clay, iron and talc
117
Examples of organic exposures (edible)
Moldy hay, silage, moldy sugar cane, mushroom compost, barley, cheese, wood pulp, cork dust, bird poop and paint
118
Define hypersensitivity pneumonitis
Immune response to lungs due to inhaled antigen like grain first or bird poop
119
What is pleurisy most commonly associated with
Rheumatoid arthritis
120
Demographic with idiopathic interstitial pneumonia
Men 40-70 confirmed by open lung biopsy. They live 4-10 years after diagnosis
121
Is ILD restrictive
Yes with low DLCO
122
What will be seen on CXR with ILd
Granuloma, cavity formation, honeycombing and pleural effusion
123
What’s the management of ILd
O2 therapy resolved hypoemia caused by thick AC membrane, fibrosis and shunting
124
Written why do pt with cor pulmonale present with jugular venous distentsion
Not enough blood pumped so there is a lot of pressure in the veins which is associated with a heart condition
