Health Asses 4: Restrictive Flashcards

Question

What pathophysiologic process in pulmonary edema leads to 'capillary stress failure'? A) Decreased surfactant production by alveolar cells B) Collapse of the alveolar air spaces C) Mechanical or ischemic disruption of the alveolar-capillary barrier D) Excessive mucous secretion in the bronchial passages

Answer 1

Correct Answer: C) Mechanical or ischemic disruption of the alveolar-capillary barrier Rationale: 'Capillary stress failure' refers to the disruption of the alveolar-capillary barrier due to mechanical or ischemic stress. This barrier is crucial for maintaining fluid homeostasis in the lungs. When it is compromised, "fluid leaks into the interstitial and alveolar spaces", leading to pulmonary edema.

Answer 2

Correct Answer: C) Bilateral symmetric perihilar opacities on imaging Rationale: Bilateral symmetric perihilar opacities on a chest X-ray are typical findings in pulmonary edema, especially when caused by increased capillary pressure. This radiographic appearance reflects the accumulation of fluid around the central areas of the lungs adjacent to the hilum.

Answer 3

Correct Answer: C) It has a higher concentration of protein and secretory products. Rationale: Pulmonary edema fluid due to ARDS, a type of non-cardiogenic pulmonary edema, is characterized by increased capillary permeability, which leads to a high concentration of protein and secretory products in the edema fluid. This is a distinguishing feature from cardiogenic pulmonary edema, which generally has a lower protein content in the fluid.

Answer 4

Correct Answer: B) It offers a rapid, non-invasive means to support the diagnosis at the patient's bedside. Rationale: Bedside lung ultrasound has emerged as a valuable tool in the diagnosis of pulmonary edema, providing a rapid, non-invasive means to detect fluid accumulation in the lungs at the patient's bedside. While it has not replaced traditional imaging methods like CXR or CT scans, it serves as a complementary tool, especially when immediate information is required.

Answer 5

Correct Answer: B) Sympathetic nervous system Rationale: Cardiogenic pulmonary edema is characterized by symptoms such as marked dyspnea, tachypnea, and elevated cardiac pressures. These symptoms are exacerbated by the activation of the Sympathetic Nervous System (SNS), which is more pronounced in cardiogenic compared to non-cardiogenic pulmonary edema.

Answer 6

Correct Answer: B) Acute aortic regurgitation Rationale: The risk of cardiogenic pulmonary edema is increased with conditions that acutely increase preload, such as acute aortic regurgitation and acute mitral valve regurgitation. These conditions can lead to sudden volume overload in the left ventricle, contributing to the development of pulmonary edema.

Answer 7

Correct Answer: C) Left ventricular outflow tract (LVOT) obstruction Rationale: Conditions that increase afterload, such as Left Ventricular Outflow Tract (LVOT) obstruction, mitral stenosis, and renovascular hypertension, can lead to an increased risk of cardiogenic pulmonary edema. LVOT obstruction increases the resistance against which the heart must pump, leading to elevated cardiac pressures and contributing to pulmonary edema.

Answer 8

Correct Answer: B) Diminished ejection fraction on echocardiography Rationale: A decreased ejection fraction observed on echocardiography indicates diminished systolic cardiac function, which can be a contributing factor to cardiogenic pulmonary edema. Echocardiography is a key diagnostic tool for assessing cardiac function, including both systolic and diastolic function. Reduced ejection fraction specifically points to decreased systolic performance, which is when the heart has difficulty effectively pumping blood out into the systemic circulation, potentially leading to pulmonary congestion and edema.

Answer 9

Correct Answer: A) Hypotension Rationale: In cardiogenic pulmonary edema, blood pressure may be maintained at normal or even elevated levels initially due to compensatory mechanisms, such as activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system, despite decreased cardiac function. Over time, if the heart failure progresses and these mechanisms are overwhelmed, blood pressure may then fall. Therefore, the presence of normal or elevated blood pressure does not rule out cardiogenic pulmonary edema, particularly in the early compensatory stage of heart failure. Tachypnea, elevated cardiac pressures, and marked dyspnea are more consistent features of cardiogenic pulmonary edema.

Answer 10

Correct Answer: B) Increased left ventricular preload and afterload due to intense inspiratory efforts against an obstruction Rationale: Negative pressure pulmonary edema develops when there is a sudden relief from an upper airway obstruction. The vigorous inspiratory efforts against the obstruction lead to a decrease in intrapleural pressure which in turn increases the venous return to the heart (preload) and increases the left ventricular afterload. The negative intrathoracic pressure generated also increases the transmural pressure gradient across the pulmonary capillary bed, promoting the transudation of fluid into the alveolar and interstitial spaces.

Answer 11

Correct Answer: B) Bronchial asthma Rationale: NPPE is specifically associated with the relief of an acute upper airway obstruction, which includes conditions like laryngospasm, epiglottitis, and obstructive sleep apnea (OSA), where the obstruction is at the level of the upper airway. Bronchial asthma is a lower airway disorder characterized by bronchoconstriction, inflammation, and increased mucus production, and is not a common cause of NPPE.

Answer 12

Correct Answer: B) Sympathetic nervous system due to stress response Rationale: NPPE is characterized by intense sympathetic nervous system (SNS) activation as a result of the stress response to acute airway obstruction and negative intrathoracic pressures. This leads to hypertension (HTN) and central displacement of blood volume, which are contributory factors in the development of pulmonary edema.

Answer 13

Correct Answer: B) A few minutes to 2-3 hours Rationale: The onset of NPPE can vary, but typically it ranges from a few minutes to 2-3 hours after the relief of the upper airway obstruction. It is an acute event that follows the pathophysiological sequence of relief from the obstruction, increased venous return, increased left ventricular afterload, and finally the transudation of fluid into the lungs.

Answer 14

Correct Answer: D) It results in increased venous return and left ventricular afterload, contributing to pulmonary edema. Rationale: In the setting of negative pressure pulmonary edema, a significant decrease in intrapleural pressure, particularly due to forceful inspiratory efforts against an obstructed airway, enhances venous return to the right side of the heart. This increased preload, along with the negative pressure exerted on the lung vasculature, leads to an increased left ventricular afterload. The augmented afterload, coupled with the stress response-induced hypertension, intensifies the pressure in the left side of the heart. These hemodynamic changes, together with the negative pressure's effect on the pulmonary capillaries, facilitate the translocation of fluid from the capillaries into the interstitial and alveolar spaces, resulting in pulmonary edema.

Answer 15

Correct Answer: B) Providing supplemental oxygen and ensuring airway patency Rationale: The mainstay of treatment for NPPE involves providing supplemental oxygen to address hypoxemia and ensuring that the airway is patent to facilitate adequate ventilation. NPPE is usually self-limited, and these supportive measures are typically sufficient while the edema resolves spontaneously.

Answer 16

Correct Answer: B) Within 12-24 hours Rationale: The radiographic evidence of NPPE generally resolves relatively quickly, usually within 12-24 hours after the episode. This resolution coincides with the self-limiting nature of the condition and the effectiveness of supportive care including oxygen therapy and ensuring a patent airway.

Answer 17

Correct Answer: C) When supplemental oxygen and a patent airway do not suffice Rationale: Mechanical ventilation may be required in the treatment of NPPE if the initial management with supplemental oxygen and maintaining a patent airway is not effective in relieving hypoxemia and respiratory distress. It is not used preventively in all cases nor routinely upon diagnosis but is reserved for cases where conservative measures are inadequate.

Answer 18

Correct Answer: B) Generalized vasoconstriction and blood volume shift into the pulmonary circulation due to sympathetic nervous system discharge Rationale: Neurogenic pulmonary edema is caused by a massive sympathetic discharge following an acute CNS injury. This outpouring of sympathetic impulses leads to generalized vasoconstriction and a consequent shift of blood volume into the pulmonary circulation, increasing pulmonary capillary pressure, and promoting the translocation of fluid into the pulmonary interstitium and alveoli.

Answer 19

Correct Answer: C) Minutes to hours after the injury Rationale: Neurogenic pulmonary edema can develop rapidly, often within minutes to hours after an acute CNS injury. It may present during the perioperative period, which is a critical time when the patient is under close observation, and any acute changes in respiratory function can be readily noted and addressed.

Answer 20

Correct Answer: B) Injury to pulmonary blood vessels due to pulmonary hypertension and hypervolemia Rationale: The increased pulmonary capillary pressure and blood volume within the pulmonary circulation, secondary to intense sympathetic nervous system activation in neurogenic pulmonary edema, can lead to pulmonary hypertension and hypervolemia. These changes increase the stress on pulmonary blood vessels, which can result in injury to the vessel walls.

Answer 21

Correct Answer: D) Rapid re-expansion of a collapsed lung Rationale: One of the key risk factors for REPE is the rapid re-expansion of a collapsed lung. This can cause a sudden shift in pressures within the thoracic cavity and lead to the development of pulmonary edema. A more controlled re-expansion is less likely to cause REPE.

Answer 22

Correct Answer: C) Enhanced capillary membrane permeability Rationale: The high protein content in the edema fluid of REPE suggests that the underlying mechanism involves enhanced permeability of the pulmonary capillary membrane, allowing proteins to pass from the capillaries into the alveolar space.

Answer 23

Correct Answer: B) Supplemental oxygen and careful fluid management Rationale: Supportive care for REPE typically includes supplemental oxygen to maintain adequate oxygenation and careful fluid management to prevent further exacerbation of pulmonary edema. It aims to support the patient's respiratory function while the condition resolves spontaneously.

Answer 24

Correct Answer: D) Larger volume of air or fluid in the pleural space Rationale: A larger volume of air or liquid in the pleural space (>1 liter) increases the risk of developing REPE when the lung is re-expanded. The pleural space's capacity to accommodate large volumes can lead to significant changes in intrapleural pressure during re-expansion.

Answer 25

Correct Answer: B) More than 24 hours Rationale: The risk of REPE is increased if the lung has been collapsed for an extended period, particularly more than 24 hours. Longer durations of collapse can lead to alterations in lung and pleural space physiology that contribute to the risk of edema upon re-expansion.

Answer 26

Correct Answer: B) Increased capillary permeability contributing to the edema Rationale: A high protein concentration in pulmonary edema fluid is indicative of increased capillary permeability, also known as non-cardiogenic or high-permeability pulmonary edema. This type of edema is characteristic of drug-induced pulmonary edema rather than cardiogenic causes, which usually result in a transudative edema with lower protein content.

Answer 27

Correct Answer: C) Pulmonary vasoconstriction and myocardial ischemia Rationale: Cocaine can induce pulmonary edema through its effects on the cardiovascular system, which include causing pulmonary vasoconstriction and the potential to induce acute myocardial ischemia. These effects contribute to the development of pulmonary edema.

Answer 28

Correct Answer: D) Opioid-induced pulmonary edema is not mediated by opioid receptors. Rationale: Naloxone is an opioid antagonist that reverses the central nervous system effects of opioids, including respiratory depression. However, opioid-induced pulmonary edema is a non-receptor-mediated effect. Therefore, naloxone does not reverse the pulmonary complications associated with opioid overdose.

Answer 29

Correct Answer: B) Intubation and mechanical ventilation Rationale: Supportive care, including intubation and mechanical ventilation, may be necessary for the treatment of drug-induced pulmonary edema, especially if the patient is in respiratory distress. This helps maintain adequate oxygenation and ventilation while the effects of the drug subside and the edema resolves.

Answer 30

Correct Answer: A) Diuretics Rationale: If a patient's pulmonary edema is refractory to diuretic treatment, it suggests that the edema may not be of cardiogenic origin. Diffuse alveolar hemorrhage (DAH) is a condition that presents with similar symptoms to pulmonary edema but involves bleeding into the alveoli. It is not typically responsive to diuretics, as the issue is related to bleeding rather than fluid overload.

Answer 31

Correct Answer: B) 2500m Rationale: HAPE can occur at altitudes typically ranging from 2500 to 5000 meters above sea level. The risk increases with the rate of ascent to high altitude and with higher altitudes.

Answer 32

Correct Answer: B) Hypoxic pulmonary vasoconstriction leading to increased pulmonary vascular pressure Rationale: The primary mechanism thought to cause HAPE is hypoxic pulmonary vasoconstriction in response to the lower oxygen levels at high altitudes. This hypoxia-induced response increases pulmonary vascular pressure and can lead to a high-permeability type of pulmonary edema.

Answer 33

Correct Answer: D) 48-72 hours Rationale: HAPE usually develops gradually and typically manifests within 48-72 hours after arrival at a high altitude.

Answer 34

Correct Answer: C) Supplemental oxygen and rapid descent to a lower altitude Rationale: Immediate treatment for HAPE includes administration of supplemental oxygen and a rapid descent to a lower altitude, which are critical for reducing hypoxia and pulmonary arterial pressure, thereby alleviating symptoms.

Answer 35

Correct Answer: B) Inhalation of nitric oxide Rationale: Inhalation of nitric oxide is a treatment option that may improve oxygenation in HAPE by causing vasodilation in the pulmonary vasculature, thus reducing pulmonary hypertension and aiding in the relief of edema

Answer 36

Correct Answer: B) Postponement until cardiorespiratory function is optimized Rationale: Elective surgery should be delayed in patients with pulmonary edema, and efforts should be made to optimize cardiorespiratory function before proceeding with surgery. This helps to minimize perioperative risks and complications related to the edema.

Answer 37

Correct Answer: B) Low tidal volume (TV) ventilation and a respiratory rate (RR) of 14-18 breaths per minute Rationale: Current evidence supports the benefit of ventilation using low tidal volume and a respiratory rate of 14-18 while keeping end-inspiratory plateau pressures below 30 cm H2O. This approach can help to prevent additional lung injury caused by mechanical ventilation, such as ventilator-induced lung injury (VILI).

Answer 38

Correct Answer: B) Hemodynamic monitoring Rationale: Hemodynamic monitoring is particularly useful in the assessment and treatment of pulmonary edema, as it helps in understanding the fluid status and cardiac function of the patient, thereby guiding appropriate fluid management and cardiovascular support.

Answer 39

Correct Answer: B) Optimize lung compliance and oxygenation Rationale: The careful titration of positive end-expiratory pressure (PEEP) along with an inspiratory pause is recommended to optimize lung compliance, which can be reduced in pulmonary edema. This helps to enhance oxygenation while minimizing potential ventilator-induced lung injury.

Answer 40

Correct Answer: A) Patients with RLD can have rapid, shallow breathing as a baseline. Rationale: Patients with restrictive lung disease often present with rapid, shallow breathing as a baseline respiratory pattern due to their decreased lung compliance. Therefore, tachypnea should not be used as the sole criterion for delaying extubation if gas exchange and other assessments are satisfactory.

Answer 41

Correct Answer: B) Patients with decreased airway reflexes Rationale: Patients with decreased airway reflexes are at an increased risk for aspiration, which can lead to chemical pneumonitis. These reflexes are critical for protecting the airway during swallowing and other times when foreign material could enter the respiratory tract.

Answer 42

Correct Answer: C) To reduce the risk of aspiration Rationale: Elevating the head of the bed (HOB) during intubation and extubation is a maneuver to decrease the risk of aspiration. By using gravity, this position helps prevent gastric contents from entering the respiratory tract if regurgitation occurs.

Answer 43

Correct Answer: B) Abrupt onset of dyspnea, tachycardia, and desaturation Rationale: Chemical pneumonitis usually presents with an abrupt onset of symptoms such as dyspnea, tachycardia, and desaturation due to the acute inflammatory response in the lungs after aspiration of gastric contents.

Answer 44

Correct Answer: B) No evidence of aspiration pneumonitis Rationale: A chest x-ray may not show evidence of aspiration pneumonitis for 6-12 hours following the aspiration event. The radiographic changes take time to develop as the inflammatory response evolves in the lung parenchyma.

Answer 45

Correct Answer: C) The superior segment of the right lower lobe (RLL) Rationale: If a patient aspirates in the supine position, the aspirated material is most likely to be found in the superior segment of the right lower lobe due to the anatomical orientation of the bronchial tree and the effect of gravity on the aspirated contents.

Answer 46

Correct Answer: B) Suction the oropharynx and turn the patient to the side. Rationale: If aspiration is noted, immediate suctioning of the oropharynx and turning the patient to the side are important to prevent further aspiration and to clear the already aspirated material from the oropharynx.

Answer 47

Correct Answer: C) It prevents aspiration once gastric contents are in the pharynx. Rationale: The Trendelenburg position will not stop an active reflux, but if gastric contents have refluxed into the pharynx, it can prevent further aspiration by using gravity to keep the contents from moving into the lower respiratory tract.

Answer 48

Correct Answer: C) It reflects the pH of the aspirated fluid and its potential for causing lung injury. Rationale: Measurement of gastric fluid pH is useful in chemical pneumonitis because the acidity of the aspirated fluid can cause lung injury. A lower pH is associated with a higher risk of chemical injury to the lungs.

Answer 49

Correct Answer: B) Aspirated gastric fluid is rapidly redistributed in the lungs, making it difficult to remove. Rationale: Once gastric fluid is aspirated, it quickly spreads to peripheral lung regions, making it difficult to remove by lavage. Additionally, lavage may not be effective in removing the fluid and could potentially exacerbate the situation by spreading it further or causing additional trauma.

Answer 50

Correct Answer: B) If the patient remains symptomatic after 48 hours and has positive culture results Rationale: Antibiotics are not routinely used in the initial treatment of aspiration pneumonitis because there is no evidence that they decrease the incidence of pulmonary infection or alter outcomes. They may be considered if a patient remains symptomatic after 48 hours and has positive culture results, indicating a secondary bacterial infection.

Answer 51

Correct Answer: B) Tetrahydrocannabinol (THC) Rationale: EVALI has been associated with additives in vaping products, most notably tetrahydrocannabinol (THC), vitamin E acetate, and other oils. These substances have been implicated in causing lung injury among e-cigarette users.

Answer 52

Correct Answer: B) Dyspnea, cough, and chest pain Rationale: The typical symptoms of EVALI include respiratory symptoms such as dyspnea, cough, and chest pain. Patients may also experience systemic symptoms like nausea, vomiting, diarrhea, abdominal pain, and fever. Pt may be febrile, tachycardia, tachypnea, and hypoxic

Answer 53

Correct Answer: C) Acute Respiratory Distress Syndrome (ARDS) Rationale: Radiologic findings in EVALI often resemble the diffuse alveolar damage seen in ARDS, which includes bilateral opacities on imaging studies without evidence of cardiac failure or fluid overload.

Answer 54

Correct Answer: B) Antibiotics, systemic steroids, and supportive care Rationale: The treatment for EVALI typically includes the administration of antibiotics to cover potential secondary bacterial infection, systemic steroids to reduce inflammation, and supportive care, which may include oxygen therapy, mechanical ventilation, and management of associated symptoms.

Answer 55

Correct Answer: B) The patient demonstrates systemic symptoms such as fever or tachycardia. Rationale: While there is no direct evidence that antibiotics decrease the incidence of pulmonary infection or alter outcomes in EVALI, they may be considered if the patient presents with systemic symptoms such as fever or tachycardia, which could indicate a possible bacterial superinfection.

Answer 56

Correct Answer: B) Persistent inflammatory interstitial lung disease Rationale: Survivors of severe COVID-19 can experience long-term pulmonary complications, including persistent inflammatory interstitial lung disease, which can manifest as fibrosis and continued respiratory symptoms such as dyspnea.

Answer 57

Correct Answer: C) A drop in diffusion capacity Rationale: The most commonly reported pulmonary function test finding among COVID-19 survivors is a drop in diffusion capacity, which reflects the severity of initial disease and possible damage to the alveolar-capillary membrane.

Answer 58

Correct Answer: B) Mechanical ventilation Rationale: Patients who have needed mechanical ventilation during their acute COVID-19 illness are at the highest risk for developing long-term pulmonary complications, due to the severity of their respiratory involvement.

Answer 59

Correct Answer: B) Decreased exercise capacity, hypoxia, and opacities Rationale: CT scans of COVID-19 survivors often show residual opacities indicative of inflammation or fibrosis, along with clinical findings of decreased exercise capacity and hypoxia, which align with restrictive lung disease.

Answer 60

Correct Answer: C) The severity of the initial disease process correlates with a drop in diffusion capacity. Rationale: There is a direct relationship between the severity of the initial COVID-19 disease process and subsequent pulmonary function, where a more severe initial presentation correlates with a greater drop in diffusion capacity, indicative of long-term lung damage.

Answer 61

Correct Answer: C) 60 mmHg Rationale: ARF is present when the partial pressure of oxygen (PaO2) is less than 60 mmHg despite oxygen supplementation and in the absence of a right-to-left intracardiac shunt.

Answer 62

Correct Answer: C) 50 mmHg Rationale: A PaCO2 greater than 50 mmHg in the absence of respiratory-compensated metabolic alkalosis is consistent with the diagnosis of ARF, indicating hypoventilation and the inability to remove carbon dioxide effectively.

Answer 63

Correct Answer: C) Increased PaCO2 and decreased pH Rationale: ARF is characterized by an abrupt increase in PaCO2 and a decrease in pH, reflecting respiratory acidosis due to acute impairment of ventilation.

Answer 64

Correct Answer: C) PaCO2 increased, pH normal Rationale: In chronic respiratory failure, the PaCO2 is increased, but the pH is normal. This indicates a chronic process where the kidneys have had time to compensate for the respiratory acidosis by increasing bicarbonate, thereby normalizing the pH.

Answer 65

Correct Answer: B) Patent airway, correction of hypoxemia, and removal of excess CO2 Rationale: The three primary treatment goals for ARF are to ensure a patent airway, correct hypoxemia, and remove excess CO2. These goals are directed at stabilizing the patient's respiratory status and improving gas exchange.

Answer 66

These devices seldom provide 02 concentrations >50%, therefore are only helpful in mild to moderate V/Q mismatching what the slide says but I think C. is actually 60-100% concentration.

Answer 67

Correct Answer: B) PaO2 falls below 60 mmHg Rationale: CPAP may be initiated when methods such as oxygen delivery via nasal cannula or masks fail to maintain a PaO2 above 60 mmHg. CPAP helps by increasing lung volumes and reducing shunting.

Answer 68

Correct Answer: B) It increases lung volumes by opening collapsed alveoli. Rationale: CPAP helps to increase lung volumes by delivering continuous positive pressure to the airways, which can help to open collapsed alveoli and improve oxygenation in conditions with V/Q mismatch.

Answer 69

Correct Answer: B) An increased risk of aspiration, particularly in patients with nausea and vomiting Rationale: CPAP via face mask can increase the risk of aspiration, especially in patients experiencing nausea and vomiting, due to the positive pressure that may force gastric contents into the pharynx and then into the lungs.

Answer 70

Correct Answer: B) Greater than 90% Rationale: Maintaining a PaO2 greater than 60 mmHg is generally considered adequate because it typically corresponds to an oxygen saturation (SpO2) greater than 90%, which ensures sufficient oxygen delivery to the tissues.

Answer 71

Correct Answer: C) Tidal volume (TV) Rationale: In volume-cycled ventilation, the primary control variable is the tidal volume (TV), which is set to deliver a fixed volume of air with each mechanical breath, regardless of the pressure (dependent variable) needed to deliver that volume.

Answer 72

Correct Answer: C) Prevents excessive airway pressure by stopping the flow of gas Rationale: A pressure limit can be set in volume-cycled ventilation to prevent excessive inflation pressure. When this set limit is reached, the pressure relief valve opens to stop further gas flow, protecting the patient from high airway pressures.

Answer 73

Correct Answer: C) Worsening pulmonary edema, pneumothorax, or obstruction in the endotracheal tube Rationale: Significant increases in PAP can be a sign of worsening pulmonary edema, the presence of a pneumothorax, a kink in the endotracheal tube (ETT), or a mucus plug obstructing the airway. These conditions can lead to increased resistance to ventilation and increased PAP.

Answer 74

Correct Answer: C) It cannot compensate for leaks in the delivery system. Rationale: A disadvantage of volume-cycled ventilation is the inability to compensate for leaks in the ventilation system. If a leak occurs, the set tidal volume may not be completely delivered to the patient's lungs, potentially compromising ventilation.

Answer 75

Correct Answer: B) Assisted/Controlled (A/C) ventilation and Synchronized Intermittent Mandatory Ventilation (SIMV) Rationale: The primary modes of volume-cycled ventilation are Assisted/Controlled (A/C) ventilation, where the ventilator fully supports each breath, and Synchronized Intermittent Mandatory Ventilation (SIMV), which allows for spontaneous breathing efforts between the mandatory ventilator-delivered breaths.

Answer 76

Correct Answer: B) The passage of a set time interval Rationale: In A/C ventilation, if the patient does not initiate an inspiratory effort, the ventilator will automatically deliver a breath at a preset rate based on the passage of a set time interval.

Answer 77

Correct Answer: B) It provides mandatory breaths in synchrony with the patient's inspiratory efforts. Rationale: SIMV permits spontaneous ventilation (SV) while providing a predefined minute ventilation. The ventilator circuit provides sufficient gas flow and delivers periodic mandatory breaths that are synchronized with the patient's spontaneous inspiratory efforts.

Answer 78

Correct Answer: C) It encourages the use of respiratory muscles, potentially improving patient-ventilator coordination. Rationale: The theoretical advantages of SIMV over A/C include the continued use of respiratory muscles, which may prevent muscle atrophy, lower mean airway and intrathoracic pressure, prevention of respiratory alkalosis, and potentially improved patient-ventilator coordination.

Answer 79

Correct Answer: B) It provides gas flow until a preset airway pressure is reached. Rationale: Pressure-cycled ventilation differs from volume-cycled by delivering gas flow to the lungs until a preset airway pressure is reached. The tidal volume (dependent variable) varies with changes in compliance and airway resistance, and is not fixed as in volume-cycled ventilation.

Answer 80

Correct Answer: C) Intubation Rationale: In mechanically ventilated patients, intubation is the most important predisposing factor for developing nosocomial pneumonia, also known as ventilator-associated pneumonia (VAP). The process of intubation can allow microorganisms to bypass normal upper airway defenses, leading to infection.

Answer 81

Correct Answer: C) Micro-aspiration of contaminated secretions around the endotracheal tube cuff Rationale: VAP is primarily caused by the micro-aspiration of contaminated secretions around the endotracheal tube (ETT) cuff. These secretions can harbor pathogens that may then enter the lower respiratory tract and cause infection.

Answer 82

Correct Answer: B) Use of systemic decongestants and head elevation Rationale: The treatment of nosocomial sinusitis in mechanically ventilated patients may include antibiotics, systemic decongestants to reduce mucosal swelling, replacement of nasal tubes with oral tubes to prevent obstruction of sinus drainage, and head elevation to facilitate sinus drainage.

Answer 83

Correct Answer: B) Subcutaneous emphysema and pneumomediastinum Rationale: Barotrauma from mechanical ventilation may present with subcutaneous emphysema, pneumomediastinum, pneumoperitoneum, pneumopericardium, pulmonary interstitial emphysema, arterial gas embolism, or tension pneumothorax. These conditions are due to the passage of air from ruptured alveoli into the extra-alveolar spaces.

Answer 84

Correct Answer: C) By weakening the pulmonary tissue and making it more susceptible to injury Rationale: Infections can weaken the structural integrity of the pulmonary tissue, making it more susceptible to rupture and subsequent barotrauma when exposed to the positive pressures of mechanical ventilation.

Answer 85

Correct Answer: B) Atelectasis Rationale: Atelectasis, or the collapse of lung tissue, is a common cause of hypoxemia during mechanical ventilation. When atelectasis is present, increasing the fraction of inspired oxygen (FiO2) may not effectively improve oxygenation because the area of the lung affected is not participating in gas exchange. (this is bullshit, unless every single alveoli collapse)

Answer 86

Correct Answer: B) Endotracheal tube (ETT) for migration, kinks, or mucous plugs Rationale: In the event of acute desaturation, it is important to check the ETT for migration, kinks, or occlusion by mucous plugs, as these can obstruct airflow and lead to hypoxemia.

Answer 87

Correct Answer: A) Tension pneumothorax (PTX) and pulmonary embolism (PE) Rationale: Sudden hypoxemia in mechanically ventilated patients may also be caused by conditions such as tension pneumothorax and pulmonary embolism, which are often accompanied by hypotension (HoTN) and require immediate attention.

Answer 88

Correct Answer: C) Bedside lung ultrasound (LUS) Rationale: Bedside lung ultrasound (LUS) can be used to identify atelectasis in mechanically ventilated patients. It is a non-invasive tool that can show static air bronchograms indicative of atelectasis.

Answer 89

Correct Answer: C) To remove mucous plugs that may be obstructing the airways Rationale: Bronchoscopy may be necessary to remove mucous plugs in mechanically ventilated patients. Mucous plugs can obstruct the airways and contribute to atelectasis, and their removal is crucial for restoring ventilation to the affected lung areas.

Answer 90

Correct Answer: C) The adequacy of oxygen exchange across alveolar capillaries Rationale: PaO2 is a measure of the oxygen level in the blood and reflects how well oxygen is able to move from the lungs to the blood, indicating the efficacy of the alveolar capillary oxygen exchange process.

Answer 91

Correct Answer: B) It measures the difference between alveolar PaO2 and arterial PaO2, helping to assess gas exchange. Rationale: The A-a oxygen gradient helps in assessing the efficacy of gas exchange within the lungs by measuring the difference between the alveolar concentration of oxygen (PaO2) and the arterial concentration of oxygen (PaO2). An increased A-a gradient can indicate issues with gas exchange due to various pulmonary pathologies.

Answer 92

Correct Answer: C) Improvement in all mechanisms Rationale: When supplemental oxygen is provided, there is typically an improvement in arterial hypoxemia across various mechanisms such as hypoventilation, V/Q mismatch, or diffusion impairment. However, the degree of improvement can vary, with conditions like right-to-left shunts showing a poor response compared to other causes.

Answer 93

Correct Answer: C) <60 mmHg Rationale: Significant desaturation of arterial blood typically occurs when the PaO2 falls below 60 mmHg, indicating a critical level of hypoxemia that stimulate compensatory responses. At a partial pressure of oxygen (PaO2) of 60 mmHg, arterial blood is typically around 90% saturated with oxygen

Answer 94

Correct Answer: B) Right-to-left pulmonary shunting Rationale: While increasing the FiO2 can improve the PaO2 in conditions like V/Q mismatch and hypoventilation, it has minimal to no effect in the case of significant right-to-left pulmonary shunting, where blood bypasses the oxygenation process in the lungs.

Answer 95

Correct Answer: B) A decrease in PaO2 to less than 60 mmHg Rationale: Compensatory responses are stimulated by an acute decrease in PaO2 below 60 mmHg, as the body attempts to maintain adequate tissue oxygenation despite the low arterial oxygen levels.

Answer 96

Correct Answer: B) When PaO2 is below 50 mmHg Rationale: In chronic hypoxemia, compensatory responses such as carotid body-induced hyperventilation, hypoxic pulmonary vasoconstriction, and increased sympathetic nervous system activity are typically activated when PaO2 falls below 50 mmHg. These responses help to maintain oxygen delivery to the tissues.

Answer 97

Correct Answer: B) Increased cardiac output (COP) and alveolar ventilation Rationale: Chronic hypoxemia leads to compensatory mechanisms to increase oxygen delivery, including increased alveolar ventilation (stimulated by the carotid body), hypoxic pulmonary vasoconstriction to divert blood away from hypoxic areas of the lung, and increased sympathetic nervous system activity to enhance cardiac output and peripheral oxygen delivery.

Answer 98

Correct Answer: C) Pulmonary embolism Rationale: Pulmonary embolism is a condition that can create areas in the lungs with adequate ventilation but inadequate perfusion, thereby increasing the dead space ventilation. This is because the blood clots block the pulmonary vasculature, leading to areas where alveoli are ventilated but not perfused, thus not participating in gas exchange, which is the definition of dead space.

Answer 99

Correct Answer: C) An increase in VD:VT ratio due to air trapping and ventilation-perfusion mismatch. Rationale: COPD often leads to air trapping and a ventilation-perfusion mismatch due to obstruction of airways and destruction of lung parenchyma. These changes can increase the proportion of ventilation that is not involved in gas exchange, thereby increasing the VD:VT ratio.

Answer 100

Correct Answer: B) Increased erythropoiesis and RBC mass in response to hypoxemia Rationale: While increased RBC mass is a compensatory mechanism in response to chronic hypoxemia to improve oxygen carrying capacity, it does not directly affect the VD:VT ratio. The other options directly relate to ventilation-perfusion mismatch or decreased perfusion, both of which can increase dead space ventilation.

Answer 101

Correct Answer: C) PaCO2 Rationale: The partial pressure of carbon dioxide (PaCO2) in arterial blood gases is directly related to alveolar ventilation. A decrease in alveolar ventilation leads to an increase in PaCO2, whereas an increase in alveolar ventilation will decrease PaCO2. PaO2 and SaO2 reflect the oxygenation status of the blood and HCO3- is more reflective of metabolic processes and compensation for respiratory changes.

Answer 102

Correct Answer: C) A possible increase in physiological dead space indicative of a pulmonary pathology Rationale: A VD:VT ratio greater than 0.3 and approaching 0.6 indicates a possible increase in physiological dead space, often associated with pulmonary pathologies such as pulmonary embolism, acute respiratory failure, or a decrease in cardiac output. A normal VD:VT ratio is generally ≤0.3 in healthy individuals. Thus, a value of 0.55 would be considered diagnostic of increased dead space ventilation and suggest a need for further evaluation for underlying pulmonary issues. slide says may increase above >= 0.6

Answer 103

Correct Answer: D) To avoid potential barotrauma from mechanical ventilation Rationale: Permissive hypercapnia is a strategy that allows a higher than normal PaCO2 to avoid the potentially harmful effects of aggressive mechanical ventilation, such as barotrauma or volutrauma, particularly in patients with conditions like acute respiratory distress syndrome (ARDS). This strategy acknowledges that a certain level of hypercapnia can be tolerated to minimize lung injury from high ventilation pressures or volumes.

Answer 104

Correct Answer: C) Increased intracranial pressure (ICP) Rationale: Acute increases in PaCO2 can lead to vasodilation of cerebral vessels, which in turn can increase cerebral blood flow (CBF) and consequently intracranial pressure (ICP). This can be particularly detrimental in patients with head injuries or other conditions where increased ICP is dangerous.

Answer 105

Correct Answer: D) To facilitate protective lung strategies in mechanical ventilation Rationale: The rationale behind allowing a higher PaCO2 (e.g., 55mmHg) is to enable the use of lower tidal volumes and pressures in mechanical ventilation, which are known as lung protective strategies. These strategies can decrease the risk of ventilator-induced lung injury, including barotrauma and volutrauma, particularly in patients with ARDS.

Answer 106

Correct Answer: B) A patient with a rapid increase in PaCO2 to 50mmHg within hours experiencing confusion and lethargy Rationale: The rate of increase in PaCO2 is a critical factor in symptom manifestation. A rapid rise in PaCO2 can lead to acute cerebral vasodilation, increased intracranial pressure, and symptoms such as confusion and lethargy, necessitating immediate intervention. In contrast, a gradual increase often allows time for compensatory mechanisms to mitigate symptom severity, and chronic hypercapnia may be well-tolerated if it is stable and the patient is adapted to it.

Answer 107

Correct Answer: D) PaCO2 of greater than 80mmHg Rationale: Extreme increases in PaCO2, such as levels greater than 80mmHg, are associated with significant central nervous system (CNS) depression. This condition can manifest as diminished consciousness or coma and requires immediate intervention to restore normal ventilation and gas exchange to prevent further deterioration of the patient's neurological status and overall health.

Answer 108

Correct Answer: B) To assess for the presence of acidemia or alkalemia and their potential causes Arterial hypoxemia is assoc w/ metabolic acidosis Rationale: The measurement of arterial pH is essential to detect deviations from the normal pH range, indicating acidemia or alkalemia. Acidemia can be a result of respiratory or metabolic dysfunction, leading to conditions such as dysrhythmias and pulmonary hypertension. Alkalemia can result from respiratory alkalosis due to mechanical hyperventilation and from metabolic causes such as diuretic use leading to chloride and potassium loss. Identifying these pH imbalances is critical for determining the underlying disorder and guiding appropriate treatment.

Answer 109

Correct Answer: B) Increased pulmonary vascular resistance Rationale: Acidemia can lead to a number of cardiovascular complications, one of which is increased pulmonary vascular resistance. This is due to the vasoconstrictive effects of acidosis on the pulmonary vasculature, which can also contribute to pulmonary hypertension. These changes can compromise pulmonary circulation and exacerbate respiratory distress.

Answer 110

Correct Answer: C) Ventilator dependence Rationale: In patients recovering from ARF, alkalemia can occur as a result of compensatory hypoventilation, which is the body's response to correct the high pH. However, this can pose a challenge in weaning the patient from the ventilator, as the body's drive to breathe may be reduced due to the correction of alkalosis, leading to prolonged ventilator dependence.

Answer 111

Correct Answer: C) Respiratory alkalosis Rationale: Respiratory alkalosis, which can be caused by mechanical hyperventilation, often results in renal compensation that includes increased excretion of chloride and potassium ions to balance the pH. The loss of these ions can contribute to the development of alkalemia and its associated complications, including dysrhythmias.

Answer 112

Correct Answer: B) 2-5% Rationale: A physiologic shunt is a normal part of pulmonary circulation, typically comprising 2-5% of the cardiac output. It accounts for the small amount of blood that does not participate in gas exchange because it bypasses ventilated alveoli.

Answer 113

Correct Answer: C) The contributions of V/Q mismatch and intrapulmonary shunting. Rationale: Determining the shunt fraction with a patient breathing less than 100% oxygen allows assessment of both V/Q mismatch and intrapulmonary shunt effects on oxygenation, as both can contribute to hypoxemia.

Answer 114

Correct Answer: B) Nonventilated alveoli Rationale: Intrapulmonary shunting occurs when blood passes through nonventilated alveoli, leading to hypoxemia due to the mixture of oxygenated and deoxygenated blood.

Answer 115

Correct Answer: A) Physiologic Rationale: Blood that passes directly to the left side of the circulation through the bronchial and thebesian veins is part of the normal physiologic shunting in the lungs.

Answer 116

Correct Answer: B) The dilution of oxygenated blood with oxygen-poor blood Rationale: Intrapulmonary shunting leads to a decrease in PaO2 due to the mixing of oxygenated blood from ventilated alveoli with hypo-oxygenated blood from unventilated alveoli, causing overall dilution.

Answer 117

Correct Answer: C) To isolate the intrapulmonary shunt effect on gas exchange Rationale: When a patient breathes 100% oxygen, the contribution of V/Q mismatch to hypoxemia is minimized, allowing for the specific calculation of shunt fraction to reflect only the impact of intrapulmonary shunting. This helps in identifying true shunt physiology, which is important for diagnosing certain pulmonary conditions and guiding appropriate treatment.

Answer 118

Correct Answer: A) PaO2 of >80 mm Hg with an FiO2 of <0.5 Rationale: The correct parameter according to the guidelines for discontinuing mechanical ventilation is a PaO2 of >60 mm Hg with an FiO2 of <0.5, not >80 mm Hg. The other listed criteria are consistent with the guidelines presented for ventilator weaning.

Answer 119

Correct Answer: B) RR of <20 Rationale: The guidelines suggest that a patient should have a respiratory rate (RR) of less than 20 breaths per minute to be considered for a trial of spontaneous ventilation, as part of the criteria for weaning from mechanical ventilation.

Answer 120

Correct Answer: A) Adequate muscle strength and endurance Rationale: A vital capacity of >15 mL/kg suggests that the patient has sufficient respiratory muscle strength and endurance, which are important indicators of the patient's ability to breathe independently without mechanical support.

Answer 121

Correct Answer: A) Adequate spontaneous ventilatory drive Rationale: A negative inspiratory pressure more negative than −20 cmH2O signifies a strong spontaneous ventilatory drive, which is a critical factor in determining a patient's readiness to wean from mechanical ventilation.

Answer 122

Correct Answer: B) Synchronized Intermittent Mandatory Ventilation (SIMV) Rationale: SIMV allows the patient to breathe spontaneously while providing a set number of mandatory breaths. The frequency of these mandatory breaths can be progressively reduced as the patient's spontaneous breathing effort improves, facilitating weaning.

Answer 123

Correct Answer: D) Showing signs of respiratory distress and potential weaning failure Rationale: Rapid breathing rates combined with low tidal volumes often indicate inadequate ventilation and the potential for respiratory muscle fatigue, suggesting that the patient may not tolerate extubation well.

Answer 124

Correct Answer: B) Breathe entirely on their own without assistance Rationale: The T-piece trial involves the total removal of mechanical support, allowing clinicians to assess the patient's ability to maintain adequate respiration unassisted, which is a crucial step in determining readiness for extubation.

Answer 125

Correct Answer: C) Gradually reduce the ventilatory assistance as the patient's respiratory strength improves - (vent weaning) Rationale: PSV is used to support the patient’s spontaneous breathing efforts with a preset amount of positive pressure. As the patient's condition improves, the level of pressure support is gradually reduced, allowing the respiratory muscles to adapt and take on more work.

Answer 126

Correct Answer: B) >60 mmHg Rationale: The target PaO2 level during weaning is greater than 60 mmHg with an FiO2 of less than 0.5 to ensure sufficient oxygenation without excessive oxygen supplementation.

Answer 127

Correct Answer: C) PaCO2 of <60 mmHg Rationale: The correct target for PaCO2 when considering ventilator weaning is to remain below 50 mmHg, not 60 mmHg. The other options are established parameters for evaluating a patient's readiness for weaning.

Answer 128

Correct Answer: C) Ability to generate an effective cough and clear secretions Rationale: The ability to generate an effective cough and clear secretions is crucial for a patient's readiness for extubation. It indicates that the patient may be able to maintain airway patency without mechanical support.

Answer 129

Correct Answer: B) Ventilation-perfusion (V/Q) mismatching Rationale: After extubation, patients often require supplemental oxygen due to V/Q mismatching, which can persist or become evident once the patient is no longer receiving the controlled ventilation support.

Answer 130

Correct Answer: C) Measurements of PaO2 and/or monitoring of SpO2 Rationale: Oxygen weaning should be guided by objective measurements of arterial oxygenation (PaO2) and the saturation of peripheral oxygen (SpO2), ensuring the patient is safely receiving the appropriate amount of supplemental oxygen.

Answer 131

Correct Answer: B) Sepsis Rationale: Sepsis is known to be the condition most strongly associated with the highest risk of ARDS due to the systemic inflammatory response and the release of cytokines that can lead to widespread lung damage.

Answer 132

Correct Answer: B) Rapid-onset respiratory failure and arterial hypoxemia Rationale: The hallmarks of ARDS include rapid-onset respiratory failure and arterial hypoxemia, with chest X-ray findings that may mimic cardiogenic pulmonary edema despite a non-cardiogenic origin.

Answer 133

Correct Answer: B) Progression to fibrosing alveolitis with persistent arterial hypoxemia Rationale: While acute ARDS can resolve completely, it may also progress to chronic conditions such as fibrosing alveolitis, characterized by persistent arterial hypoxemia and decreased pulmonary compliance due to lung scarring and fibrosis.

Answer 134

Correct Answer: C) Increasing alveolar capillary membrane permeability and alveolar edema Rationale: In ARDS, the release of proinflammatory cytokines leads to increased permeability of the alveolar capillary membrane, contributing to alveolar edema and impairing gas exchange.

Answer 135

Correct Answer: A) Ventilation with high tidal volumes Rationale: Supportive care in ARDS typically avoids high tidal volumes to prevent ventilator-induced lung injury and instead focuses on lung-protective strategies with lower tidal volumes. Antibiotics, stress ulcer prophylaxis, and early enteral feeding are all components of supportive care in ARDS management.

Answer 136

Correct Answer: C) Improvement of V/Q matching by recruitment of lung units Rationale: Prone positioning is utilized in ARDS to improve oxygenation by recruiting atelectatic lung units and optimizing ventilation-perfusion (V/Q) matching due to the redistribution of pulmonary blood flow and the effects of gravity.

Answer 137

Correct Answer: B) Rest the lungs while providing adequate gas exchange Rationale: ECMO is used in the management of severe ARDS to allow the lungs to rest by taking over the gas exchange function, which can be especially beneficial in cases of severe hypoxemia and respiratory acidosis unresponsive to conventional treatment.

Answer 138

Correct Answer: D) Beta-blocker therapy Rationale: While optimal fluid management, the use of neuromuscular blockade agents, and systemic corticosteroids are part of supportive therapies in ARDS, beta-blocker therapy is not typically included in this management strategy.

Answer 139

Correct Answer: B) Selectively dilating pulmonary vessels to improve V/Q matching Rationale: Inhaled nitric oxide is used in ARDS for its selective pulmonary vasodilation effects, which can improve V/Q matching and oxygenation without causing systemic vasodilation.

Answer 140

Correct Answer: C) Re-expand collapsed alveoli Rationale: Recruitment maneuvers in ARDS involve transient increases in airway pressure to open (or 'recruit') collapsed alveoli, thereby improving oxygenation and lung compliance.

Answer 141

Correct Answer: B) Chronic bronchitis Rationale: Chronic bronchitis is characterized by chronic productive cough and is typically classified under obstructive lung diseases, unlike the other conditions listed, which are types of ILD and exhibit restrictive lung physiology.

Answer 142

Correct Answer: B) Restrictive Rationale: ILD is associated with restrictive physiology due to the stiffening of lung parenchyma, which restricts the expansion of the lungs, leading to a decrease in lung volumes.

Answer 143

Correct Answer: B) Dyspnea and nonproductive cough Rationale: Patients with ILD commonly present with dyspnea on exertion and a dry, nonproductive cough due to the underlying parenchymal involvement without significant airway hypersecretion.

Answer 144

Correct Answer: B) Loss of pulmonary vasculature and fibrosis Rationale: Progressive pulmonary fibrosis in ILD can cause obliteration of the pulmonary capillary bed, leading to increased pulmonary vascular resistance, which in turn can lead to pulmonary hypertension and cor pulmonale (right-sided heart failure).

Answer 145

correct answer: D) Lungs and intrathoracic lymph nodes Rationale: Sarcoidosis most commonly affects the respiratory system, with granulomatous inflammation typically involving the lungs and intrathoracic lymph nodes.

Answer 146

Correct Answer: C) Conduction abnormalities and dysrhythmias Rationale: Myocardial sarcoidosis can cause granulomatous changes in the heart, leading to conduction abnormalities and various dysrhythmias due to disruption of the normal electrical pathways within the myocardium.

Answer 147

Correct Answer: C) Increased calcium absorption mediated by vitamin D dysregulation Rationale: In sarcoidosis, hypercalcemia occurs due to the dysregulation of vitamin D by activated macrophages within granulomas, which increases calcium absorption from the gut. Hypercalcemia is a classic manifestation of sarcoidosis

Answer 148

Correct Answer: C) Can interfere with intubation Rationale: Laryngeal sarcoidosis, which occurs in up to 5% of patients, can cause airway obstruction or distortion due to granulomatous changes, thus potentially complicating intubation efforts.

Answer 149

B) Unilateral facial nerve palsy

Answer 150

Correct Answer: C) Angiotensin-converting enzyme (ACE) Rationale: Angiotensin-converting enzyme (ACE) activity is often increased in sarcoidosis, as it is produced by the epithelioid cells of granulomas. This increase can be used as a marker in the diagnosis and management of the disease.

Answer 151

Correct Answer: B) To reduce inflammation and suppress symptoms Rationale: Corticosteroids are the mainstay treatment for sarcoidosis because of their potent anti-inflammatory effects, which can suppress the granulomatous inflammation that characterizes the disease and treat hypercalcemia often seen in sarcoidosis.

Answer 152

Correct Answer: C) Mediastinoscopy, endobronchial ultrasound, and bronchoscopy Rationale: Tissue diagnosis of sarcoidosis often requires procedures such as mediastinoscopy, endobronchial ultrasound, and bronchoscopy to obtain tissue samples or lavage fluid for histological examination.

Answer 153

Correct Answer: A) Hypercalcemia Rationale: Hypercalcemia is a classic manifestation of sarcoidosis, although it is not present in all patients. It results from increased production of calcitriol by activated macrophages in granulomas.

Answer 154

Correct Answer: C) Development of pulmonary hypertension Rationale: Progressive pulmonary fibrosis can lead to obliteration of the pulmonary vascular bed and increased pulmonary vascular resistance, potentially culminating in pulmonary hypertension.

Answer 155

Correct Answer: D) C-reactive protein (CRP) Rationale: While CRP is a marker of inflammation, it is not specifically associated with sarcoidosis. Serum amyloid A, adenosine deaminase, and serum soluble IL2 receptor are markers that can be elevated in sarcoidosis and help in supporting the diagnosis.

Answer 156

Correct Answer: C) Ground-glass opacities Rationale: Hypersensitivity pneumonitis, on computed tomography (CT) scans, typically shows ground-glass opacities, especially in the mid to upper lung zones, indicating inflammation and interstitial changes due to the immune response to inhaled antigens.

Answer 157

Correct Answer: D) 1-4 hours Rationale: The symptoms of hypersensitivity pneumonitis characteristically appear 4-6 hours after exposure to the antigen. Symptoms developing within 1-4 hours are not typical for this condition and may suggest a different etiology.

Answer 158

Correct Answer: B) Antigen avoidance and glucocorticoids Rationale: The primary treatment for hypersensitivity pneumonitis involves avoiding further exposure to the inciting antigen and the use of glucocorticoids to reduce the inflammatory response in the lungs. In severe cases, a lung transplant may be considered.

Answer 159

Correct Answer: C) Pulmonary fibrosis Rationale: Chronic and repeated episodes of hypersensitivity pneumonitis can cause progressive lung damage and scarring, leading to pulmonary fibrosis. This can result in chronic respiratory failure and other serious complications.

Answer 160

Correct Answer: B) Leukocytosis and eosinophilia Rationale: After inhalation of the antigen causing hypersensitivity pneumonitis, there is often an acute inflammatory response characterized by leukocytosis (an increase in white blood cells) and eosinophilia (an increase in eosinophils). These findings reflect the immune system's response to the inhaled allergens.

Answer 161

Correct Answer: C) It denotes an allergic response contributing to inflammation. Rationale: Eosinophilia in the context of hypersensitivity pneumonitis is significant as it denotes an allergic or hypersensitivity reaction within the lungs contributing to the overall inflammatory process.

Answer 162

Correct Answer: B) Tobacco smoking Rationale: Pulmonary Langerhans Cell Histiocytosis has a strong association with tobacco smoking, which is considered the most significant risk factor for the development of this disease.

Answer 163

Correct Answer: C) Cysts or honeycombing in the upper lung zones with costophrenic sparing Rationale: CT scans of patients with Pulmonary Langerhans Cell Histiocytosis typically show cysts or honeycombing patterns in the upper zones of the lungs, with sparing of the costophrenic angles, which is a distinctive feature that can be diagnostic of the disease.

Answer 164

Correct Answer: C) Langerhans cells Rationale: The histological hallmark of Pulmonary Langerhans Cell Histiocytosis is the presence of Langerhans cells within the inflammatory lesions around the bronchioles. These cells can be identified by their characteristic appearance and immunohistochemical staining.

Answer 165

Correct Answer: B) Smoking cessation and systemic glucocorticoids Rationale: The cornerstone of treatment for Pulmonary Langerhans Cell Histiocytosis involves smoking cessation to halt the progression of the disease, along with the use of systemic glucocorticoids to reduce inflammation and provide symptomatic relief.

Answer 166

Correct Answer: C) Batwing distribution of alveolar opacities Rationale: The batwing or butterfly pattern distribution of alveolar opacities, typically in the middle and lower lung zones, is a characteristic radiographic feature of PAP seen on a chest X-ray.

Answer 167

Correct Answer: B) Performing whole-lung lavage under general anesthesia Rationale: Whole-lung lavage under general anesthesia is the treatment of choice for severe cases of PAP to remove the accumulated proteinaceous material in the alveoli and improve macrophage function, thereby enhancing gas exchange and alleviating symptoms.

Answer 168

Correct Answer: B) Double-lumen endotracheal tube (DLT) Rationale: The use of a double-lumen endotracheal tube (DLT) allows for selective isolation and ventilation of one lung while the other is being lavaged, which is crucial for maintaining oxygenation during the procedure in patients with PAP who are at risk of hypoxemia.

Answer 169

Correct Answer: C) Acquired immunodeficiency syndrome (AIDS) Rationale: PAP may occur independently or in association with other conditions, including immunodeficiency states such as AIDS, exposure to certain chemicals or dust, or following chemotherapy, reflecting a disruption in normal alveolar macrophage function.

Answer 170

Correct Answer: C) Women of reproductive age Rationale: Lymphangioleiomyomatosis is a rare multisystem disorder that primarily occurs in women of reproductive age, characterized by the proliferation of smooth muscle cells, which can affect the lungs, lymphatics, and blood vessels.

Answer 171

Correct Answer: C) Combined restrictive and obstructive disease with decreased diffusing capacity Rationale: Patients with LAM may exhibit a mixed restrictive and obstructive pattern on pulmonary function tests, often accompanied by a decreased diffusing capacity due to the disease's impact on lung architecture and function.

Answer 172

Correct Answer: B) Sirolimus (immunosuppressive therapy) Rationale: Sirolimus, an immunosuppressive agent, has been shown to be beneficial in the treatment of LAM by slowing disease progression in symptomatic patients, likely due to its inhibitory effect on the mTOR pathway, which is involved in cell growth and proliferation.

Answer 173

Correct Answer: D) Chronic productive cough Rationale: LAM is characterized by progressive dyspnea, hemoptysis, recurrent pneumothorax, and pleural effusions. A chronic productive cough is not typically a feature of LAM and is more commonly associated with conditions involving chronic bronchial inflammation or infection.

Answer 174

Correct Answer: C) Increased RV and decreased VC Rationale: As a person ages, physiological changes in the lungs and chest wall, such as decreased chest wall compliance and decreased elastic recoil, lead to an increased residual volume (RV) due to less effective exhalation, and decreased vital capacity (VC) due to reduced total lung capacity.

Answer 175

Correct Answer: C) Increase in the anteroposterior (AP) diameter of the chest Rationale: An increase in the anteroposterior (AP) diameter of the chest, often due to kyphosis or changes in thoracic spine curvature associated with aging, can alter the orientation and thus the mechanical efficiency of the diaphragm during breathing.

Answer 176

Correct Answer: B) FRC increases as a compensatory mechanism to maintain oxygenation Rationale: In older adults, the functional residual capacity (FRC) often increases due to changes in lung and chest wall mechanics. Geriatric patients tend to breathe at higher lung volumes to compensate for the decreased elasticity and compliance of the respiratory system.

Answer 177

Correct Answer: A) Forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) Rationale: Aging is commonly associated with a decline in both FEV1 and FVC on pulmonary function testing, reflecting changes in lung mechanics such as decreased compliance and elastic recoil. This decline can be more pronounced in patients with increased airway reactivity.

Answer 178

Correct Answer: C) Ankylosing spondylitis, flail chest, scoliosis, and kyphosis Rationale: Chronic extrinsic RLD is often related to structural deformities of the thoracic cage such as ankylosing spondylitis, flail chest, scoliosis, and kyphosis, which can interfere with normal lung expansion and mechanics.

Answer 179

Correct Answer: B) It increases due to abnormal mechanics and increased airway resistance Rationale: In chronic extrinsic RLD, the work of breathing is increased due to the abnormal chest wall mechanics that result in increased airway resistance and decreased lung volumes, making the effort of breathing more labor-intensive.

Answer 180

Correct Answer: C) Right ventricular dysfunction due to compression of pulmonary vasculature Rationale: Thoracic deformities can lead to compression of the pulmonary vasculature, increasing the resistance against which the right ventricle must pump. This can eventually lead to right ventricular dysfunction.

Answer 181

Correct Answer: C) Recurrent pulmonary infections Rationale: A reduced ability to cough effectively, which is common in chronic extrinsic restrictive lung diseases, leads to an inability to clear secretions from the respiratory tract, predisposing patients to recurrent pulmonary infections.

Answer 182

Correct Answer: C) Scoliosis and kyphosis Rationale: Scoliosis and kyphosis are the two types of spinal deformities that can lead to chronic extrinsic restrictive lung disease due to their impact on the thoracic cage and its capacity to expand, often resulting in restrictive lung impairment.

Answer 183

Correct Answer: C) More respiratory compromise Rationale: Patients with kyphoscoliosis due to neuromuscular disorders typically experience more severe respiratory compromise than those with idiopathic kyphoscoliosis because the neuromuscular etiology often affects both the structure and function of respiratory muscles, leading to a more pronounced impairment.

Answer 184

Correct Answer: C) The degree of spinal curvature Rationale: The degree of respiratory compromise in patients with kyphoscoliosis is directly correlated with the severity of the spinal curvature. Greater curvature can more significantly restrict lung expansion, leading to reduced ventilatory capacity and increased work of breathing.

Answer 185

Correct Answer: B) In late childhood/early adolescence Rationale: Kyphoscoliosis commonly begins in late childhood or early adolescence, which are periods of rapid skeletal growth. This is when the signs and symptoms of the deformity and the associated respiratory compromise often start to become evident.

Answer 186

Correct Answer: C) Pigeon chest Rationale: Pectus carinatum is commonly referred to as "pigeon chest." It is characterized by a protrusion of the sternum and ribs and, while often considered a cosmetic issue, can be associated with respiratory symptoms.

Answer 187

Correct Answer: B) Flail chest Rationale: Flail chest occurs due to multiple rib fractures causing a segment of the chest wall to become detached from the rest of the thoracic cage. This results in paradoxical movements during breathing, where the segment moves inward on inspiration and outward on expiration.

Answer 188

Correct Answer: C) Increased work of breathing and pain Rationale: Patients with flail chest experience increased work of breathing due to the instability of the chest wall and pain due to the multiple rib fractures. This condition can lead to respiratory compromise and is considered a medical emergency.

Answer 189

Correct Answer: C) Positive pressure ventilation until stabilization Rationale: Treatment for flail chest typically involves the use of positive pressure ventilation to stabilize the affected segment of the chest wall, improve ventilation, and support breathing while the underlying fractures heal.

Answer 190

Correct Answer: C) Bedside ultrasound (US) Rationale: Bedside ultrasound is the preferred method for diagnosing pleural effusion as it is highly sensitive, can be performed at the bedside, allows for the evaluation of fluid characteristics, and can guide therapeutic procedures if needed.

Answer 191

Correct Answer: B) Tall, thin men aged 20-40 Rationale: Idiopathic spontaneous pneumothorax commonly occurs in tall, thin men between the ages of 20-40 and is often attributed to the rupture of apical subpleural blebs.

Answer 192

Correct Answer: D) Needle decompression or placement of a chest tube Rationale: A tension pneumothorax is a life-threatening condition that requires immediate intervention to relieve the pressure in the pleural space. This is typically achieved by needle decompression or insertion of a chest tube in the second anterior intercostal space, which can be lifesaving.

Answer 193

Correct Answer: C) Tracheal deviation away from the side of the pneumothorax Rationale: In a tension pneumothorax, the build-up of pressure in the pleural space can push the mediastinum and trachea away from the affected side, which is an important clinical sign indicating the severity of the condition.

Answer 194

Correct Answer: C) Bacterial contamination following esophageal perforation Rationale: Acute mediastinitis is commonly caused by bacterial contamination, which can occur as a result of esophageal perforation. This serious condition is associated with symptoms such as chest pain and fever and requires prompt treatment with broad-spectrum antibiotics and surgical drainage.

Answer 195

Correct Answer: B) Thymomas Rationale: Thymomas are the most common masses found in the anterior mediastinum, comprising about 20% of mediastinal tumors. Other anterior mediastinal masses can include germ cell tumors, lymphomas, intrathoracic thyroid tissue, and parathyroid lesions.

Answer 196

Correct Answer: C) Decortication Rationale: Surgical decortication may be considered for patients with pleural fibrosis who are symptomatic. This procedure involves the removal of thick, fibrous tissue to allow better lung expansion and function.

Answer 197

Correct Answer: C) Intrathoracic thyroid tissue Rationale: Intrathoracic thyroid tissue is generally located in the anterior mediastinum. Posterior mediastinal masses more commonly include neurogenic tumors and cysts, meningoceles, lymphomas, descending aortic aneurysms, and esophageal diverticula and neoplasms.

Answer 198

Correct Answer: C) To evaluate for airway compression Rationale: A flow-volume loop is measured preoperatively to assess for the presence and degree of airway compression by a mediastinal mass, as it can reveal extrathoracic or intrathoracic obstruction.

Answer 199

Correct Answer: C) Fiberoptic bronchoscopy Rationale: Fiberoptic bronchoscopy is a valuable tool for directly visualizing the airways and assessing the extent and nature of airway obstruction caused by a mediastinal mass.

Answer 200

Correct Answer: C) Mass radiation Rationale: Preoperative radiation therapy may be considered to decrease the size of a mediastinal mass, particularly if it is causing symptomatic compression of the trachea or other critical structures.

Answer 201

Correct Answer: B) It is not indicative of the degree of respiratory compromise that may be encountered during anesthesia. Rationale: The severity of preoperative pulmonary compromise does not always correlate with the degree of respiratory compromise that can be encountered during anesthesia, as even asymptomatic patients can develop severe airway obstruction when anesthetized.

Answer 202

Correct Answer: C) Local anesthetic (LA) technique Rationale: For symptomatic patients who require a tissue biopsy of a mediastinal mass, a local anesthetic technique is preferred to avoid the risks associated with general anesthesia, such as exacerbation of airway compression or respiratory compromise.

Answer 203

Correct Answer: B) Autosomal recessive Thoracic cause of restrictive lung disease. Rationale: Asphyxiating thoracic dystrophy (Jeune syndrome) is an autosomal recessive disorder, meaning that it typically requires two copies of the mutated gene, one from each parent, for the disorder to manifest in the offspring.

Answer 204

Correct Answer: B) Variation in bone morphogenetic protein (BMP) type 1 Rationale: Fibrodysplasia ossificans progressiva is a hereditary disorder caused by a genetic variation in the bone morphogenetic protein (BMP) type 1, leading to abnormal ossification of connective tissue.

Answer 205

Correct Answer: C) Poland syndrome Rationale: Poland syndrome is characterized by the partial or complete absence of the pectoral muscles on one side of the body, which can lead to asymmetry and potentially paradoxical respiratory motion due to the absence of multiple ribs.

Answer 206

Correct Answer: C) Paradoxical respiratory motion Rationale: Due to the absence of the pectoral muscles and possibly multiple ribs, patients with Poland syndrome may display paradoxical respiratory motion, where the chest wall moves inward during inspiration instead of outward.

Answer 207

Correct Answer: D) Respiratory muscle strength Rationale: Neuromuscular disorders can impair the central nervous system's input to the respiratory muscles, leading to weakened respiratory muscles and an inability to generate normal respiratory pressures, which is a hallmark of restrictive lung defects in these conditions.

Answer 208

Correct Answer: B) Reduced ability to cough effectively Rationale: Expiratory muscle weakness in neuromuscular disorders hampers the ability to generate sufficient airflow during coughing, leading to an ineffective cough and potential difficulty in clearing airway secretions.

Answer 209

Correct Answer: C) Wakefulness Rationale: Patients with severe neuromuscular disorders often depend on their state of wakefulness to maintain adequate ventilation, as the decreased muscle tone during sleep can exacerbate ventilatory insufficiency.

Answer 210

Correct Answer: B) 20-25% Rationale: About 20-25% of patients with Guillain-Barré syndrome may require mechanical ventilation (2 months) due to the disease's effect on the respiratory muscles, which can lead to respiratory failure.

Answer 211

Correct Answer: B) Hypoxemia and hypercapnia Rationale: During sleep, patients with neuromuscular disorders may experience hypoventilation leading to hypoxemia (low oxygen levels) and hypercapnia (elevated carbon dioxide levels), which can contribute to increased pulmonary arterial pressure and the development of cor pulmonale (right-sided heart failure).

Answer 212

Correct Answer: B) Non-depolarizing neuromuscular blockers (ND-NMBs) Rationale: Patients with Myasthenia gravis are particularly sensitive to the effects of non-depolarizing neuromuscular blockers (ND-NMBs) due to their underlying neuromuscular transmission defect and are often resistant to the effects of succinylcholine.

Answer 213

Correct Answer: C) Chronic alveolar hypoventilation Rationale: Chronic alveolar hypoventilation occurs in Muscular Dystrophy mainly due to inspiratory muscle weakness, leading to inadequate ventilation and the risk of respiratory failure, especially during sleep

Answer 214

Correct Answer: B) Impaired cough and risk of aspiration Rationale: Expiratory muscle weakness in Muscular Dystrophy impairs the ability to cough effectively, increasing the risk of pulmonary aspiration and subsequent respiratory complications.

Answer 215

Correct Answer: A) They can exacerbate muscle weakness Rationale: CNS depressant drugs should be minimized or avoided in patients with Muscular Dystrophy because they can further depress respiratory drive and exacerbate already compromised respiratory muscle function.

Answer 216

Correct Answer: B) Below T4 Rationale: In quadriplegic patients with a spinal cord injury below T4, diaphragmatic breathing is maintained because the phrenic nerve, which innervates the diaphragm, originates from the C3-C5 spinal segments. Therefore, injuries below T4 typically spare the diaphragm.

Answer 217

Correct Answer: C) Coughing Rationale: Since the diaphragm is active only during inspiration, high spinal cord injuries lead to an inability to cough effectively because coughing relies on expiratory muscle action which is affected by the injury.

Answer 218

Correct Answer: B) Paradoxical inward motion of the upper thorax during inspiration Rationale: With diaphragmatic breathing, particularly in the context of high spinal cord injuries, there is often a paradoxical motion where the upper thorax moves inward during inspiration due to the lack of intercostal muscle function, resulting in diminished TV.

Answer 219

Correct Answer: C) Anticholinergic bronchodilators Rationale: Anticholinergic bronchodilators can be used to reverse mild bronchial constriction in quadriplegic patients. This bronchial constriction is due to unopposed parasympathetic tone as a result of the lack of sympathetic innervation from the spinal cord.

Answer 220

Correct Answer: A) Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), functional residual capacity (FRC), expiratory reserve volume (ERV) Rationale: Obesity is associated with decreases in several lung volumes including FEV1, FVC, FRC, and ERV due to the increased chest wall mass, which limits expansion and increases the work of breathing.

Answer 221

Correct Answer: B) FRC may exceed the closing volume and approach the residual volume (RV) - sounds like losing the ERV Rationale: In extreme cases of clinical obesity, FRC may increase to levels that exceed the closing volume of the lungs, which is the volume at which small airways begin to collapse, and can approach the residual volume (RV), the volume of air remaining in the lungs after a maximal exhalation.

Answer 222

Correct Answer: C) It is usually preserved. Rationale: Despite reductions in absolute values of FEV1 and FVC in obesity, their ratio (FEV1:FVC) is typically preserved, indicating that obesity affects both volumes proportionally and does not typically produce an obstructive ventilatory defect.

Answer 223

Correct Answer: B) They release adipocytokines that contribute to systemic inflammation and respiratory disorders. Rationale: Adipocytes release adipocytokines, which are involved in systemic inflammation and can contribute to the development of various respiratory disorders in obesity, such as hypoxemia, OSA, obesity hypoventilation syndrome, and potentially COPD.

Answer 224

Correct Answer: B) Diminishes basal lung expansion and causes closure of peripheral lung units Rationale: The accumulation of adipose tissue in the anterior abdominal wall in individuals with obesity can limit the movement of the diaphragm, diminishing basal lung expansion and leading to closure of peripheral lung units, especially at lower lung volumes.

Answer 225

Correct Answer: B) By causing a restrictive lung physiology Rationale: Pregnancy can lead to a restrictive lung physiology as the enlarging uterus pushes the diaphragm upward, which reduces the volume of the lungs during inhalation. Additionally, the expanding rib cage and stretching of the lower rib cage ligaments due to hormones like relaxin contribute to this change.

Answer 226

Correct Answer: B) Increased levels of relaxin causing stretching of the lower rib cage ligaments Rationale: The hormone relaxin, which increases during pregnancy, causes the ligaments of the pelvis and the lower rib cage to stretch, leading to an increase in the anteroposterior and transverse diameters of the chest walls and an expanded rib cage circumference.

Answer 227

Correct Answer: B) At the 37th week of pregnancy Rationale: The changes in chest wall configuration due to pregnancy, such as the widening of the subcostal angle and increase in chest circumference, typically peak at the 37th week of pregnancy.

Answer 228

Correct Answer: C) About 6 months postpartum Rationale: The chest wall configuration generally normalizes about 6 months after delivery, with the exception of the subcostal angle, which remains wider by about 20%.

Answer 229

Correct Answer: B) 4 cm Rationale: The enlarging uterus during pregnancy pushes the diaphragm upward by about 4 cm, contributing to the changes in lung volumes and mechanics during pregnancy.

Answer 230

Correct Answer: C) They can exacerbate existing hypoventilation and lead to further respiratory compromise. Rationale: In RLD, where lung compliance is already reduced, drugs with prolonged respiratory depressant effects can further diminish respiratory drive and exacerbate hypoventilation, worsening the patient's respiratory status.

Answer 231

Correct Answer: C) Intraoperative mechanical ventilation to facilitate optimal oxygenation Rationale: Intraoperative mechanical ventilation is important in managing patients with RLD, as it can help maintain optimal oxygenation, especially because these patients may not be able to generate sufficient tidal volumes on their own due to poor lung compliance.

Answer 232

Correct Answer: B) Increased inspiratory pressures to overcome decreased lung compliance Rationale: Due to the decreased lung compliance associated with RLD, increased inspiratory pressures may be necessary during mechanical ventilation to ensure adequate gas exchange.

Answer 233

Correct Answer: C) By contributing to the risk of perioperative pulmonary complications Rationale: RLD increases the risk of perioperative pulmonary complications due to the limited reserve in lung function, which can be further compromised by the effects of anesthesia, surgical positioning, and the inflammatory response to surgery.

Answer 234

Correct Answer: D) Due to impaired pulmonary function that may not recover immediately after anesthesia Rationale: Patients with RLD may require postoperative mechanical ventilation because their already impaired pulmonary function can be further compromised by anesthesia and surgery, and it may not recover immediately, necessitating continued ventilatory support.

Answer 235

Correct Answer: B) Fiberoptic bronchoscopy Rationale: Fiberoptic bronchoscopy has largely replaced rigid bronchoscopy because it is less invasive and can be used for visualizing the airways, obtaining samples for culture, cytologic examination, and biopsy with less discomfort and risk to the patient.

Answer 236

Correct Answer: B) 5-10% Rationale: Pneumothorax occurs in approximately 5-10% of patients after a transbronchial lung biopsy, which is a known risk of the procedure due to the potential for puncturing the lung tissue. 10-20% after percutaneous needle biopsy of peripheral lung lesions

Answer 237

Correct Answer: B) Coagulopathy Rationale: The presence of a coagulopathy is a major contraindication for pleural biopsy due to the increased risk of bleeding during and after the procedure.

Answer 238

Correct Answer: B) Right innominate artery Rationale: During mediastinoscopy, the mediastinoscope can exert pressure on the right innominate artery, which can lead to a loss of pulses in the right arm and compromise of right carotid artery blood flow.

Answer 239

Correct Answer: A) Pneumothorax, mediastinal hemorrhage, venous air embolism, and recurrent laryngeal nerve (RLN) injury Rationale: Mediastinoscopy, a surgical procedure to examine the mediastinum, carries risks including pneumothorax, bleeding within the mediastinum (mediastinal hemorrhage), venous air embolism, and injury to the recurrent laryngeal nerve which can affect voice and breathing. Mediastinoscopy is performed under GA through a small transverse incision just above the suprasternal notch

Health Asses 4: Restrictive Flashcards

(263 cards)