pulmonary disease

Question 1

Who’s at risk for pulmonary problems?

Answer 1

pre existing pulmonary dx, thoracic or upper abdominal surgery, smokers, obesity, age >60 years, anesthesia longer than 3 hours

Question 2

5 pulmonary symptoms that ID a patient at risk for pulmonary complications?

Answer 2

cough, expectoration, hemoptysis, chest pain, wheezing

Question 3

How do you calculate pack years?

Answer 3

length of time smoking x # of packages of cigs smoked

Question 4

Malnourished patients are predisposed to what type of pulmonary complication?

Answer 4

pneumonia

Question 5

Clubbing is often seen in what?

Answer 5

chronic lung disease and malignancy

Question 6

RR greater than what is early sign of respiratory failure?

Answer 6

25

Question 7

How is pursed lip breathing an adaptation for obstructive lung dx?

Answer 7

self PEEP

Question 8

How could you identify severe dyspnea?

Answer 8

unable to complete normal sent wout pausing for breath

Question 9

What is inspiratory paradox?

Answer 9

abdomen goes in and chest wall expands= dysfunction of diaphragm

Question 10

Reduced pulm vascular markings in hyperinflated lung volumes can be seen how on a chest xray?

Answer 10

lungs seem more translucent

Question 11

IC spaces mildly elevated so wider between ribs implies what on a chest xray?

Answer 11

use of accessory muscles for respiration so hyperinflation of lungs

Question 12

Dome flattened out and is below ant angle of __ rib so implies emphysema?

Answer 12

7th

Question 13

3 common ABG findings w pulmonary pathology?

Answer 13

PCO2>45, PaO2

Question 14

2 EKG changes in pts with lung dx?

Answer 14

low voltage QRS (bc of hyperinflation of lungs and increases distance of skin where electrodes are and electrical activity of heart), right BBB

Question 15

RBBB seen in what leads?

Answer 15

2ndary R wave in V1-3

Question 16

Where can you see cor pulmonale and pulmonary hypertension?

Answer 16

chest xray

Question 17

Examples of symptoms and signs of pulmonary dysfunction warranting PFTs?

Answer 17

symptoms- wheezing, CP, dyspnea, orthopnea, cough, phlegm; signs- diminished breath sounds, overinflation of chest, exp slowing observed as purse lip, chest/spine deformity, unexplained crackles

Question 18

IC is?

Answer 18

TV + IRV

Question 19

VC is?

Answer 19

ERV + IRV + TV

Question 20

TLC is?

Answer 20

IRV + ERV + TV + RV

Question 21

FRC is?

Answer 21

ERV + RV

Question 22

Maximal volume of air exhaled from end expiration?

Answer 22

ERV

Question 23

Maximal volume of air inhaled from end inspiration?

Answer 23

IRV

Question 24

Volume of air remaining in lungs after maximal exhalation?

Answer 24

RV

Question 25

Volume of air in the lungs at resting end expiration?

Answer 25

FRC

Question 26

Maximal volume of air that can be inhaled from the resting expiratory level?

Answer 26

IC

Question 27

Largest volume measured on complete exhalation after full inspiration?

Answer 27

VC

Question 28

Volume of air in lungs at maximal inflation?

Answer 28

TLC

Question 29

If the patient has obstructive disease, how is that manifested on a slow VC (not forced vital capacity in other words) spirometry?

Answer 29

slow VC generally higher than forced VC bc airways collapse under rapid exhalation

Question 30

Most widely used parameter to measure mechanical pressures of lung?

Answer 30

FEV1

Question 31

In normal people, FEV1 reflects what?

Answer 31

greatest part of exhaled vol and reflects mech probs of lungs and medium sized airways

Question 32

In obstructive airway dx how does that show up on FEV1/FVC?

Answer 32

FEV1 is reduced disproportionately to FVC. so ratio is

Question 33

In restrictive airway dx how does that show up on FEV1/FVC?

Answer 33

FEV1, forced VC and TLC are all reduced but FEV1/FVC ratio normal or sometimes elevated

Question 34

What is FEF 25-75%?

Answer 34

the midpoint of forced VC. so between 25 and 75 of expired vol is also called maximal midexp flow

Question 35

FEF 25-75% reflects what? And is it recommended to measure that?

Answer 35

small airway disease; no

Question 36

As a person ages, how do the lungs change?

Answer 36

less elasticity, smaller lung volumes, smaller capacities

Question 37

4 variables which affect lung volumes/capacities?

Answer 37

age, gender, height, race

Question 38

What does the volume time curve look like in obstructive lung dx?

Question 39

What does the volume time curve look like in restrictive lung dx?

Answer 39

reduced FVC, reduced FEV1, normal ratio, but lower lung volumes so under the normal curve

Question 40

Patients with obstructive dx need what 2 parameters? And what vent setting do they do better on?

Answer 40

PEEP and longer expiratory time, may do better on pressure support or pressure generated volume

Question 41

When ventilating a person with restrictive dx, what do you want to do?

Answer 41

have smaller lung capacity so want to generally bring down volumes we use and increase the rate