Respiratory Distress

Question 1

Hypoxemia results from any combination of five mechanisms

Answer 1

Hypoventilation

Right-to-left shunt

Ventilation-perfusion (V ̇/Q ̇) mismatch

Diffusion impairment

Low inspired oxygen

Question 2

occurs when blood enters the systemic circulation without traversing ventilated lung

Answer 2

Right-to-left shunt

Question 3

A hallmark of significant right-to-left shunting is

Answer 3

the failure of arterial oxygen levels to increase in response to supplemental oxygen

Question 4

increased A-a O2 gradient, and hypoxemia improves with supplemental oxygen

Answer 4

Ventilation-perfusion (V ̇/Q ̇) mismatch

Question 5

Hypoxemia mechanism in
pulmonary emboli, pneumonia, asthma, chronic obstructive pulmonary disease, and even extrinsic vascular compression

Answer 5

Ventilation-perfusion (V ̇/Q ̇) mismatch

Question 6

increased Paco2 and a normal A-a O2 gradient

Answer 6

Hypoventilation

Question 7

A-a O2 gradient is increased, and hypoxemia improves with supplemental oxygen

Answer 7

Diffusion impairment

Question 8

commonly seen at high altitude (including commercial air travel) or in nonobstructive asphyxia

Answer 8

Low inspired oxygen

Question 9

True or false

Cyanosis, the blood or tissue discoloration associated with a lowered arterial oxygenation saturation, is not a sensitive or specific indicator of hypoxemia

Answer 9

True

Question 10

True or false

Hypercapnia never results from increased CO2 production alone

Answer 10

True

Question 11

Hypercapnia is exclusively caused by______________ and is defined as a Paco2_______ (>6 kPa)

Answer 11

alveolar hypoventilation

> 45 mm Hg

Question 12

True or false

Do not withhold oxygen required to maintain minimum oxygen saturation levels in any chronic lung disease patient in an effort to stimulate ventilation and reduce hypercapnia

Answer 12

True

Question 13

Acute cough is cough lasting ____________ and is usually associated with self-limited upper respiratory or bronchial infections

Answer 13

<3 weeks

Question 14

Subacute cough lasts 3 to 8 weeks and is most commonly ___________

Answer 14

postinfectious

Question 15

most common causes of chronic cough

Answer 15

(1) smoking, often with chronic bronchitis
(2) upper airway cough syndrome (formerly postnasal discharge)
(3) asthma
(4) gastroesophageal reflux
(5) angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker therapy

Question 16

Sequential Approach to Chronic Cough

Answer 16

Question 17

Treatment of Hiccups: Physical Maneuvers

Answer 17

Question 18

only has U.S. Food and Drug Administration approval for treatment of intractable hiccups

Answer 18

chlorpromazine

Question 19

True or false

A significant pleural effusion is large enough to produce a pleural fluid strip >10 mm wide on lateral decubitus radiographic views or by US.

Answer 19

True

Question 20

Therapeutic thoracentesis with drainage of_________ L of fluid is indicated if the patient has dyspnea at rest

Answer 20

1.0 to 1.5

Question 21

Acute drainage of larger volumes is associated with________________, so large- volume drainage is to be avoided

Answer 21

reexpansion pulmonary edema

Question 22

Optimization of medical therapy typically resolves_____ of effusions due to heart failure within 2 weeks

Answer 22

> 80%

Question 23

Cytology for malignancy: highest yield is with

Answer 23

adenocarcinoma

Question 24

massive hemoptysis definition

Answer 24

ranges from

100 mL per 24 hours

to

> 1000 mL per 24 hours

midpoint value of 600 mL per 24 hours accepted by many

Question 25

__________ accounts for only 1% of the blood flow to the lungs but 90% of the cases of hemoptysis because it is a high-pressure system

Answer 25

bronchial arteries

Question 26

Rasmussen’s aneurysm

Answer 26

is a false aneurysm of dilated blood vessels crossing the wall of a tuberculosis cavity.