Disorders Of Ventilation And Gas Exchange

Front 1

list ways to detection hypoxemia

Back 1

PaO2, O2 sat, ABG's

Front 2

reduction in blood O2 levels i known as

Back 2

hypoxemia

Front 3

which would not directly result in insufficient O2:
diseases of the lung, neurologic disorders, cardiac disorders, insufficient O2 in the air, breathing into a bag

Back 3

breathing into a bag. The rest do

Front 4

Middle aged Pt presents to the ER combative, but uncoordinated. He is easily agitated by your questions. Blood test rules out alcohol. What is your next step?

Back 4

Place pt on O2, symptoms match severe hypoxia

Front 5

what is dangerous about chronic hypoxia.

Back 5

Among other things, that is insidious and you often don't realize you have a problem.

Front 6

List the four mechanisms we have to compensate for hypoxemia

Back 6

increase rate and depth of breathing
pulmonary vasoconstriction (directs blood to areas that are getting O2)
Increase in Erythropoetin which increases RBCs
shift in O2 curve to the right

Front 7

Pt presents with cyanosis of the mucous membranes and skin. Pa O2 is 96. What do you test for.

Back 7

Polycythemia may present as cyanosis without hypoxemia

Front 8

the gold standard for measurement of O2, CO2, and pH

Back 8

Arterial samples

Front 9

why would you choose to use pulse oximetry instead of ABGs

Back 9

pulse ox is less invasive and can give continual readings

Front 10

Pt brought to ED by ambulance. Was pulled from a burning house. No major burns, but smoke inhalation. PF ratio is 190. What do you suspect?

Back 10

Normal PF ratio is 300. Lower PF ratios are associated with acute lung injury and ARDS. Pt probably has burns on her lungs due to high temp of smoke inhaled.

Front 11

What is the first treatment for hypoxemia? what is the hallmark?

Back 11

Find the cause and remove
then Oxygen (hallmark)

Front 12

Why do we not leave pts on long term 100% O2

Back 12

May cause symptoms and lung injury

Front 13

when do you see hypercapnia with hypoxemia

Back 13

hypoventilation

Front 14

What may cause hypercapnia

Back 14

increased metabolism (fever, exercise), underlying renal disease (disruption of buffer system).

Front 15

how can O2 use in hypercapnia lead to coma?

Back 15

increased levels of CO2 depress the brains natural stimulus to breath. If this happens enough pt will become hypoxemic, which will iniate a different drive to breath. If you give O2 thus taking care of the hypoxemia. You take away that secondary drive to breath, but the first one is still gone because the pt is still hypercapnic. Resulting in NO drive to breath

Front 16

Match the disorder with its impact on the lung
Pneumothorax Collapse
Atelectasis Compression
Pleural effusion Restriction

Back 16

pneumothorax and PE both compress the lung, one could argue restricting its movement
Atelectasis is a collapsed segment of the lung.

Front 17

Pt experiencing pain with breathing. Upon exam you do not hear good breath sounds and is hyper-resonant upon percussion. Chest X-Ray shows tracheal shift

Back 17

pneumothorax

Front 18

The pleura of the lungs has two layers with a serous fluid between them. Name them and give location

Back 18

parietal pleura- lines inner chest cavity
visceral pleura- covers lung

Front 19

Pt presents with "sharp localized" pain upon breathing. Has history of URI w/n one week, no Hx of trauma. What do you suspect, and how do you treat? what if they did have present HX of trauma?

Back 19

Pleurisy, Nsaid or indomethacin
if HX of trauma would need to rule out chest pain due to rib fractures

Front 20

Epidemic pleurodynia is also known as... and is due to what bug

Back 20

Von Holms disease
the group B coxsackievirus

Front 21

leading causes of pleural effusion in the US

Back 21

heart failure, pneumonia, cancer

Front 22

identify the 5 mechanisms associated with PE

Back 22

increased capillary pressure
increased cap permeability (inflammation)
decreased colloidal pressure (hypoalbumin, nephrosis)
increased negative pressure (atelectasis)
impaired lymphatic drainage (obstruction often cancer)

Front 23

pt presents with chest pain, dyspnea, fever. Exam: dullness to percussion, decreased breath sounds. Egophony above the dullness. What tests do you need to order? If tests confirm your suspicion what is the treatment?What does egophony above dullness suggest.

Back 23

Chest X-ray- looking for fluid to blunt costophrenic angle (250mL)
Drain is enough fluid is present
egophony above the effusion means that that area has succumbed to atelectasis

Front 24

Why do you drain an PE

Back 24

for both treatment and as a diagnostic measure. Type of fluid can tell you origin of PE.

Front 25

PE fuid drained has protein level of 2.0 g/dl cholesterol level of 40 mg/dl protein ratio (fluid/serum)of .4 and LDH ratio of .38, pH 7.48
What is the etiology of this fluid?

Back 25

Transudate, most likely from CHF

Front 26

PE fluid drained has protein level of 3.6 g/dl, cholesterol level of 52mg/dl, protein ratio (fluid/serum)of .6 and LDH ratio of .52, pH 7.63

Back 26

Exudate, could be infection

Front 27

Exudates in PE flid are commonly associated with what

Back 27

infection, infarction, malignancies, and connective tissue disorders

Front 28

Pt has recurrent PE. you treat by instilling tetracycline and talc between the pleura, causing adhesion of the two layers. what procedure did you just perform

Back 28

pleurodesis

Front 29

Pt is 65 yo male with emphysema. Has new pain and difficulty associated with breathing. Exam yields hyper-resonance over left lower lobe

Back 29

spontaneous pneumothorax due to rupture of emphysematous bleb

Front 30

15 y/o male, has pain and difficulty associated with breathing.Has had this multiple times before. Exam yields hyper-resonance over right lower lobe. What is your diagnosis and patient education

Back 30

spontaneous catamenial pneomothorax

avoid pressure extremes (planes, scuba) and don't smoke

Front 31

some common causes of traumatic pneumothorax are knife wounds and rib fractures. what are some uncommon causes

Back 31

esophogeal perforation (watch for in severe GERD pt) and iatrogenic

Front 32

Pt presents to ER with stab wound right anterior chest just below 3rd rib. Pt is tachycardic, cyanotic, and dyspnic. Breath sounds are very diminished. Chest Xray shows shift of heart and atelectasis of L lung. DX and treament

Back 32

tension pneumothorax, large bore needle into area, if sucking cover with vaseline guaze and occlusive dressing

Front 33

When can primary atelectasis occur

Back 33

only in newborns that have never ventilated that lung

Front 34

incomplete expansion of lung

Back 34

atelectasis

Front 35

list some causes of atelectasis

Back 35

airway obstruction, lung compression due to pneumothorax or PE, inability ot take deep breaths, sedation

Front 36

Pt is in postop after GI surgery. Nurse notices fever and calls you over. Upon exam lungs are dull to percussion, and tactile fremitus is increased
DX and treatment

Back 36

atelectasis, encourage pt to take long deep breaths, reinflation of lung may be necessary

Front 37

list some obstructive airway disorders

Back 37

asthma, COPD, bronchiectasis, cystic fibrosis

Front 38

what is characteristic of all obstructive disorders

Back 38

all decrease ventilation in the airways

Front 39

what is the approximated prevelance of asthma

Back 39

1:15

Front 40

"a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role, in particular mast cells, eosinophils, t lymphocytes, and epithelial cells."

Back 40

asthma

Front 41

some common causes of traumatic pneumothorax are knife wounds and rib fractures. what are some uncommon causes

Back 41

esophogeal perforation (watch for in severe GERD pt) and iatrogenic

Front 42

Pt presents to ER with stab wound right anterior chest just below 3rd rib. Pt is tachycardic, cyanotic, and dyspnic. Breath sounds are very diminished. Chest Xray shows shift of heart and atelectasis of L lung. DX and treament

Back 42

tension pneumothorax, large bore needle into area, if sucking cover with vaseline guaze and occlusive dressing

Front 43

When can primary atelectasis occur

Back 43

only in newborns that have never ventilated that lung

Front 44

incomplete expansion of lung

Back 44

atelectasis

Front 45

list some causes of atelectasis

Back 45

airway obstruction, lung compression due to pneumothorax or PE, inability ot take deep breaths, sedation

Front 46

Pt is in postop after GI surgery. Nurse notices fever and calls you over. Upon exam lungs are dull to percussion, and tactile fremitus is increased
DX and treatment

Back 46

atelectasis, encourage pt to take long deep breaths, reinflation of lung may be necessary

Front 47

list some obstructive airway disorders

Back 47

asthma, COPD, bronchiectasis, cystic fibrosis

Front 48

what is characteristic of all obstructive disorders

Back 48

all decrease ventilation in the airways

Front 49

what is the approximated prevelance of asthma

Back 49

1:15

Front 50

"a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role, in particular mast cells, eosinophils, t lymphocytes, and epithelial cells."

Back 50

asthma

Front 51

this reponsse in asthma usually occur w/n 10-20 minutes of inhaled irritant and is most likely due to the release of mast cells

Back 51

early/acute phase response
can be modified by b- agonists (bronchodilators)

Front 52

this phase of asthma occurs 4-8 hours after irritant, but may last for days. Due to migration of inflammatory cells and epithelial injury

Back 52

late phase response

Front 53

this test should be performed on all asthma pts.
This test should be performed before and after bronchodilator use

Back 53

spirometry
Forced Expiratory Volume

Front 54

7 yo presents with wheezing and dyspnea after playing outside. Upon visual examination you notice use of accessory muscles for beathing and slight cyanosis

Back 54

asthma

Front 55

potentially fatal manifestation of acute asthma where there is lack of response to treatment resulting in cyanosis, hypoxemia, hypercarbia, and acidosis. Pt should be admitted to ICU

Back 55

status asthmaticus

Front 56

list some clinical management issues with asthma

Back 56

EDUCATION, training in proper technique and timing, should have peak flow meter, keep daily diary, and contacts in case of emergency, flu and pneumonia shots, avoid allergens

Front 57

progressive, non-reversible obstructive disease most often caused by smoking

Back 57

COPD

Front 58

36 yo pt diagnosed with emphysema. Pt has never smoked. diagnosis and treament

Back 58

alpha 1 antitrypsin (autosomal recessive)
weekly IV enzyme replacement

Front 59

the permanent enlargement of air spaces distal to the terminal bronchioles, not fibrosis

Back 59

emphysema

Front 60

clinically productive cough for 3 months in each of two sucessive years

Back 60

chronic bronchitis

Front 61

this reponsse in asthma usually occur w/n 10-20 minutes of inhaled irritant and is most likely due to the release of mast cells

Back 61

early/acute phase response
can be modified by b- agonists (bronchodilators)

Front 62

this phase of asthma occurs 4-8 hours after irritant, but may last for days. Due to migration of inflammatory cells and epithelial injury

Back 62

late phase response

Front 63

this test should be performed on all asthma pts.
This test should be performed before and after bronchodilator use

Back 63

spirometry
Forced Expiratory Volume

Front 64

7 yo presents with wheezing and dyspnea after playing outside. Upon visual examination you notice use of accessory muscles for beathing and slight cyanosis

Back 64

asthma

Front 65

potentially fatal manifestation of acute asthma where there is lack of response to treatment resulting in cyanosis, hypoxemia, hypercarbia, and acidosis. Pt should be admitted to ICU

Back 65

status asthmaticus

Front 66

list some clinical management issues with asthma

Back 66

EDUCATION, training in proper technique and timing, should have peak flow meter, keep daily diary, and contacts in case of emergency, flu and pneumonia shots, avoid allergens

Front 67

progressive, non-reversible obstructive disease most often caused by smoking

Back 67

COPD

Front 68

36 yo pt diagnosed with emphysema. Pt has never smoked. diagnosis and treament

Back 68

alpha 1 antitrypsin (autosomal recessive)
weekly IV enzyme replacement

Front 69

the permanent enlargement of air spaces distal to the terminal bronchioles, not fibrosis

Back 69

emphysema

Front 70

clinically productive cough for 3 months in each of two sucessive years

Back 70

chronic bronchitis

Front 71

most common type of emphysema affecting the bronchioles of the central lobules. most commonly seen in males with high pack years

Back 71

centrilobular emphysema

Front 72

emphysema affecting the peripheral alveoli first then extending centrally. Characteristic of alpha 1 antitrypsin deficiency

Back 72

panacinar emphysema

Front 73

chronic inflammation of the bronchial tree with thick sputum progressing to purulent sputum. generally caused by smoking. x-ray may reveal blebs and increase in bronchovascular markings

Back 73

chronic bronchitis

Front 74

emphysema pts who overventilate to keep good ABGs. develop barrel chest

Back 74

"pink puffers"

Front 75

emphysema pts who cannot compensate via hyperventilation and become cyanotic. more likely to develop pulmonary hypertension and polycythemia

Back 75

"blue bloaters"

Front 76

pt presents with hx of cough, cputum, dyspnea and smoking. Physical reveals hyper-ressonant percussion, distant breath sounds, and pursed lip breathing, Xray reveals flattened diaphragm and loss of lung markings. What do you suspect and how would you definatively diagnose

Back 76

COPD
spirometry

Front 77

classic FEV1/FVC ratio for COPD

Back 77

< .7
FEV1 of <50% = SEVERE

Front 78

total lung capacity, residual volume, and functional residual capacity all increase or decrease with advanced COPD

Back 78

increase

Front 79

1st treatment for COPD

Back 79

stop smoking

Front 80

list some treaments for COPD

Back 80

flu and pneumonia vac, oxygen (1-2 L/min when Po2 below 55 mmHG), bronchodilators, maybe theophylline, surgery (take out parts or transplantation)

Front 81

uncommon respiratory disorder characterized by dilation of the bronchi secondary to frequent infection or inflammation

Back 81

bronchiectasis

Front 82

pt presents with cough, foul smelling sputum, weight loss and clubbng. Has hx of recurrent URI.
dx and tx

Back 82

bronchiectasis
postural drainage, treatments for COPD, prophylactic antibiotics

Front 83

the most common cause of COPD in children. caused by deficiency in chromosome 7. moms diagnose by salty kisses

Back 83

cystic fibrosis

Front 84

what is the most common infecting agent exascerbating cystic fibrosis

Back 84

pseudamonas

Front 85

while screening for trypsinogen can be done, what is the gold standard for cystic fibrosis

Back 85

sweat test

Front 86

this organ is almost always involved in cystic fibrosis (besides the lungs)

Back 86

pancreas