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51 Cards in this Set

  • Front
  • Back
The central chemoreceptors are a vital control for breathing located in the medulla, what do they sense:

a. oxygen levels
b. CO2 levels
c. CO levels
d. hemoglobin levels
CO2, such that high CO2 triggers increased breathing
The peripheral chemoreceptors sense O2 and CO2 and are vital for control of breathing, where are they located

a. medulla
b. brain stem
c. cerebrum
d. carotid and aortic bodies
carotid and aortic bodies sense Oxygen and CO2 levels to regulate breathing
As you sleep there is a decrease in all EXCEPT:

a. activation of reticular activating system
b. airway resistance
c. metabolic rate
d. chemosensitivity
there is a decrease in arousal or activation of reticular activating system, metabolic rate, and chemosensitivity
EXCEPT airway resistance which actually increases due to positioning and less muscle tone
During sleep there is an increase in

a. PaCO2
b. PaO2
c. SaO2
d. TV
normally an increase in PaCO2 (2-8mmHg)
everything else decreases Pa02 (3-10mmHg), SaO2 (~2%) and tidal volume (due to muscle inhibition and increased resistance)
what is the most common cause of respiratory insufficiency during sleep:

a. restrictive disorders
b. neuromuscular disorders
c. obesity hypoventilation syndrome
d. COPD
COPD due to increased airway resistance; hence as many as 50% of people with sleep problems suffer from COPD
What condition has a major clinical affect on sleep leading to decreased sleep time, less REM, and more changes in sleep stages and increased arousal

a. COPD
b. restrictive disorder
c. neuromuscular disorder
d. obesity hypoventilation syndrome
COPD due to increased airway resistance, hypopnea (decreased ventilation) --> exacerbate hypoxemia/hpercapnea especially in advanced disease
CCOPD can increase the risk of complications in all of the following except:

a. pulmonary HTN
b. cor pulmonade
c. interstitial fibrosis
d. cardiac dysrhythmias
e. polychtemia
pulmonary HTN, cor pulmonade, cardiac dysrhythmias, and polycythemia all increase the risk of complications

NOT intersitial fibrosis
What intervention is helpful in resetting the CO2 response and reducing the bicarbonate buildup and base excess in pts with COPD and sleep problems

a. invasive surgery
b. non-invasive ventilation such as a mask
c. 3-4 pillows
d. medications
non-invasive ventilation such as the use of a mask
What is an important test to monitor annual in pts suffering from restrictive disorder when their vital capacity drops below 50%:

a. arterial blood gas
b. spirometry
c. pulmonary function test
d. DLCO
pulmonary function test
ALS (amyotrophic lateral scelrosis) is what kind of a disease affecting lung fucntion:

a. restrictive disorder
b. obstructive disorder
c. neuromuscular disorder
d. sleeping disorder
ALS is a neuromuscular chronic progressive disorder resulting in degeneration of nerve cells in CNS that control movement --> loss of control of voluntary muscle movement
What is the major concern in extremely obese patients?

a. alveolar hypoventilation during wakefulness
b. less REM sleep
c. excessive snoring
d. headaches
alveolar hypoventilation during wakefulness characterized via
hypersomnolence
dyspnea
hypoxemia with cyanosis, polycythemia
What is the dangerous damage done on the lungs due to obesity hypoventilation syndrome:

a. lung parynchemal destruciton
b. alveolar distension
c. lung hyperinflation
d. pulmonary HTN
pulmonary HTN --> RV failure and peripheral edema
Pt presents with complaints that sound like Cheyne Stokes breathing patterns, what can you conclude regarding the breathing patterns:

a. cessation or near cessation of breathing for a min of 10 sec
b. excessive snoring with episodes of apnea
c. no REM
d. cycles of hyperventilation and hypoventilation
Cheyne stokes breathing is cycles of hyperventilation and hypoventilation during sleep due to loss of ventilator effort (no brain signal to breath) lack of respiratory effort seen with central sleep apnea as opposed to obstructive sleep apnea where you will see effort of respiration during a sleep study
Obese pt presents with tonsillar hypertrophy, what kind of sleep disorder is he at risk for:

a. obstructive sleep apnea
b. central sleep apnea
c. respiratory failure
d. asthma
obstructive sleep apnea
causes:
obesity, tonsillar hypertrophy, pharyngeal muscle collapse on inspiration, nasal septum deviation
Drugs, high altitude, and heart failure are often causes of this condition

a. obstructive sleep apnea
b. central sleep apnea
c. respiratory failure
d. asthma
central sleep apnea
Obese pt presents with daytime sleepiness, headaches, and wife adds that he awakes frequently at night due to excessive snoring, what tests can be recommended

a. PFT
b. ABG's
c. stress test
d. polysomnography
sleep study Polysomnography overnight pt is suffering from obstructive sleep apnea causing increase in CO2 retention --> hypoxemia (arousing pt from sleep to get a breath)
they present with low paO2 and SaO2 during apnea, increased PCO2
Pts with obstructive sleep apnea have all of the following decreased eXCEPT:

a. PO2
b. SaO2
c. PCO2
d. respiration
PCO2 increased leading to respiratory acidosis
Pt with obstructive sleep apnea must seek treatment due to the complications of all EXCEPT

a. cardiac dysrhythmias
b. pulm HTN
c. RVHypertrophy
d. secondary polycythemia
cardiac dysrhythmias
What treatment modality is useful in both central and obstructive sleep apnea:

a. surgical correction
b. supplemental oxygen
c. weight loss
d. CPAP
CPAP is beneficial in both (nasal continuous positive airway pressure)
supplemental oxygen (central)
surgical correction and weight loss (obstructive)
During sleep our brain depends highly on PaCO2 to regulate sleep because of decreased brain activity, so if PaCO2 is lowered below a certain threshold what is the response

a. decrease in breathing (apnea)
b. hyperventilation
c. REM sleep
d. cycles of hypo/hyperventilation
hypoventilation (decrease in breathing --apnea) since high PaCO2 means hyperventilate
note: apnea threshold is lower in women, so they suffer less from central sleep apnea (it must reach a lower point than men before they begin to have apnea)
PFT's are vital in distinguishing restrictive and obstructive lung conditions. What measure is usually decreased in obstructive lung disease due to loss of elastic recoil and loss or radial support:

a. FEV1
b. FVC
c. FEV1/FVC
d. none
FEV1 hence FEV1/FVC ratio because they have trouble breathing out due to
accumulation of mucus, inflammatory cells, exudates, and smooth muscle contraction
In pts with restrictive disease such as interstitial fibrosis all are reduced EXCEPT:

a. lung volumes or TLC
b. compliance
c. FEV1/FVC ratio
d. FVC
all are reduced
lung volumes and TLC, FEV1, and FVC
EXCEPT FEV1/FVC ratio it appears normal since both FEV1 and FVC are reduced together
What is considered a normal FEV1

a. bellow 70% of predicted value
b. 60-80 % of predicted value
c. 40-60% of predicted value
d. 80-120% of predicted value
80-120% of predicted value
Pt presents with FEV1/FV ratio below 70%, what can this suggest?

a. obstruction
b. restriction
c. bronchospasms
d. normal value
obstruction condition but NO information is provided regarding severity of the disease
What follow up is required if findings indicate a low FVC to determine if truly decreased TLC?

a. helium dilution
b. nitrogen washout
c. body plethysmography
d. CXR
all of the above --> put someone in a tight box and measure the air they breath
What is the mechanism of a pulmonary test, helpful test to differentiate obstructive from restrictive diseases

a. detecting the arterial oxygen saturation (SaO2)
b. inhaling a nebulizer solution with methacholie
c. measure the amount of CO that diffuses from alveoli into the bloodstream (indirect rate of oxygen uptake)
d. chest Xray
measure the amount of CO that diffuses from alveoli into the bloodstream (indirect rate of oxygen uptake) proportional to the surface are of the lungs divided by the path SA/path

>path (edema, interstital disease) or < area (pneumonia, lung resction) = < DLCO

a. hypoxemia detection
b. asthma
Although edema, interstitial disease (< path) and pneumonia, lung resection (<area) can result in decrease in DLCO (CO diffused in the alveloli), what other component of the diffusion capacity can cause a decrease in DLCO

a. blood component, so a decrease in Hb can also cause a decrease in DLCO
b. oxygen content in alveoli can cause a decrease in DLCO
c. an increase in Hb can cause a decrease in DLCO
d. an increase in pulmonic blood flow can lead to a decrease of DLCO
blood component, so a decrease in Hb can also cause a decrease in DLCO
What can result in an increase in DLCO, and why?

a. increased oxygen content allows more oxygenation and increased DLCO
b. increasing pulmonic blood flow recruits more pulmonary capillaries and causes an increased surface area for gas exchange
c. decreased pulmonic blood flow results in less surface area and an increase in DLCO
increased oxygen content allows more oxygenation and increased DLCO
DLCO is useful in determining

a. degree of anatomical emphysema
b. degree of interstitial disease
c. degree of affected alveoli
d. degree of pneumonia
degree of interstitial disease
When using the DLCO and lung capacities, what measures suggest interstitial lung disease

a. low DLCO and elevated TLC
b. low DLCO and decreased TLC
c. normal DLCO and elevated TLC
d. normal DLCO and decreased TLC
low DLCO and decreased TLC (restrictive disease)
What is a common test for asthma diagnosis?

a. taking deep breath and exhaling as hard as you can
b. detecting arterial oxygen saturatin
c. giving metacholine (Muscarinic R agonist) to stimulate parasymnpathetic system causing braonchoconstriction
d. measuring the amount of CO that diffuse from alveoli into the blood stream
a. PFT, b. cyanosis, d. DLCO
giving metacholine (Muscarinic R agonist) to stimulate parasymnpathetic system causing braonchoconstriction; FEV1 is measured at 1, 3, 5, and 10min, then you go with a stronger solution until you see >20% decrease in FEV1 = PC20 (<8mg/ml positive for asthma)
How much of a FEV1 drop must be observed during a brochoprovocation with metacholine to consider it a positive test for asthma

a. > 10%
b. > 20%
c. > 30%
d. > 40%
> 20% decrease in FEV1
Mesotheliomas are usually found between parietal and pleural space, often due to

a. smoking
b. HTN
c. drugs (medications)
d. asbestos
asbestos
Pleural effusions result from a build up of fluid, but the cause can vary due to cardiogenic or noncardiogenic factors. What are 2 results due to decreased protein (edema) that can cause a pleural effusion

a. increased HP in visceral pleura
b. decreased oncotic P
c. obstruction of lymph drainage
d. increased vessel permeability of visceral pleural capillaries
increased HP in visceral pleural and decreased oncotic P (cardiogenic < protein

while non-cardiogenic > protein is caused by c and d
Pt presents with lung cancer due to obstruction of lymph drainage, what kind of pleural disorder can result

a. spontaneous pneumothorax
b. cardiogenic pleural effusion
c. non-cardiogenic pleural effusion
d. tension pneumothorax
(non-cardiogenic > protein )
pleural effusion as the tumor will lead to destruction of lung perychyma
ARDS is a result of the inflammatory process leading to destruction of alveoli epithelium resulting in increased protein (or non-cardiogenic pleural effusion). What is often the cause of this:

a. CHF
b. nephrotic syndrome
c. G negative bacteria (toxin)
d. cystic fibrosis
G negative bacteria toxin

CHF and nephrotic syndrome (cardiogenic pleural effusion)
Pneumonia can often lead to a pleural effusion what is the mechanism of this condition

a. increase in HP in visceral pleura
b. decreased in oncotic P
c. obstruction of lymphatic drainage
d. increased vessel permeability of visceral pleural capillaries
increased vessel permeability of visceral pleural capillaries

a and b (cardiogenic causes)
c (lung CA)
Pt presents with sob and chest pain from compression, it is determined that it is a hemothorax as a result of:

a. clear fluid
b. cloudy fluid
c. bloody fluid
d. thick, viscous fluid
blood fluid usually caused by trauma
Non-cardiogenic (> protein) in fluid is usually distinguished form cardiogenic due to

a. clear fluid
b. cloudy fluid
c. blood fluid
d. thick, viscous fluid
cloudy fluid due to the increase in protein content
Heart failure can result in a pleural effusion distinguished from a noncardiogenic effusion due to

a. transudative
b. exudative
c. hemothorax
d. thick, viscous fluid
clear fluid due to the decreased amount of proteins (transudate)
What tests in NOT informative when identifying a pneumothroax?

a. CXR
b. CT
c. US
d. MRI
MRI
CXR, CT, and US are used to identify a pleural effusion
Pt enters ED with a history of COPD complaining of a SUDDEN onset of dyspnea w/ pleuritic type chest pain. As you listen there is an absence in breath sounds. After review of the CXR you notice the diaphragm is ELEVATED. What can be the problem

a. spontaneous pneumothorax
b. tension pnuemothorax
c. pneumonia
d. pleural effusion
the lack of lung sounds and SUDDEN onset of dyspnea lead you to notice that there is collapse of lungs, now to determine the cause since there is a history of COPD, ELEVATED diaphram = spontaneous pneumothorax

other causes can include idiopathic, marfan's, CF, barotruam, penetrating trauma, iatrogenic (MD poked a hole)
16y/o male is brought to the ED after a gang fight, leaving him SUDDEN onset of SEVERE dyspnea, after lung exam you note tympanic percussion and absent breath sounds. Upon a CXR, you notice a diaphragm is depressed and there is some deviation of the trachea and mediastinal structures to contralateral side, what is the cause of the condition
this is a tension pneumothroax caused by penetrating trauma to the chest (knife wound). significant signs include severe onset of dyspnea, tympanitic percussion and absent breath sounds, also on the CXR, diaphragm is DEPRESSED
these changes can lead to compromised venous return, in addition, lung tissue is compressed by increased interpleural cavity P

quickly insert a needle into pleural space to drain air and relieve P
what is not a common result from sleep:

a. decrease in RAS
b. increase in resistance
c. increase in chemosensitivity of (oxygen and carbon dioxide)
d. decrease in metabolic rate
a. decrease in RAS
b. increase in resistance
c. increase in chemosensitivity of (oxygen and carbon dioxide) NO --- it should say decrease

making diseased STATES WOrSE!! leading to nocturnal hypoxemia and desaturation
d. decrease in metabolic rate
Normally what are the results of sleep as it relates to oxygen and carbon dioxide EXCEPT:

a. increase in PaCO2
b. increase in PaO2
c. decrease in SaO2
increase in PaCO2, decrease in PaO2, and decrease in SaO2
NOT increase in PaO2
during sleep muscle inhibition and increased resistance results in

a. increase tidal volume
b. increase in residual volume
c. decrease in tidal volume
d. decrease in residual volume
decrease in tidal volume
REM sleep is when you will notice the most pronounced respiratory changes and

a. marks the beginning of true sleep
b. has the highest brain activity
c. results in slow waves
d. low voltage EEG
has the highest brain activity (looks like awake, but muscle paralyzed (saw tooth waves are seen)
Pts with what disease state have a worst time with sleep due to the damage of the diseased state:

a. restrictive d/o
b. obstructive d/o
c. obesity
d. neuromuscular d/o
obstructive disease due to >> respiratory insufficiency!!
reduced sleep quality and hypopnea(decreased ventilation) night time changes can excacerbate hypoxemia and hypercapnea leading to increased risk of complications: PHtN, cor pulmnonade, cardiac arrhythmia, polycythemia (increased RBC)
Pt recently diagnosed with COPD, comes in to clinic stating his sleep quality has deteriorated and has been having difficulty staying awake at work. What is wrong and how can he be helped:

a. invasive tracheal tube needed
b. ventilatory support throughout the day (especially at work)
c. noninvasive ventilation such as CPAP
d. tell him to schedule sleeping pattern earlier than usual
noninvasive ventilation of CPAP will help with increased Resistance caused by sleep and COPD, the increase in O2 during sleep will elevate his threshold of CO2 (such that his body responds similar to day time)
These two conditions impair breathing due to muscle weakness and atrophy, Muscular dystrophy is a genetic defect due to the muscle, while the other condition is

a. degeneration of myelin sheath
b. lose of control of voluntary muscle movement due to loss of motor neurons
c. loss of ACh receptors necessary for movement initiatin
d. deterioration of sensory fibers
loss of control of voluntary muscle movements due to loss of motor neurons as seen in ALS amotrophic lateral sclerosis
Pt presents with daytime drowsiness and AM headaches with irritability, after recommending an overnight sleep study documented periods of apnea were reviewed resulting in low PO2 and SaO2, but increase in PCO2 leading to respiratory acidosis, what can be the cause of his conditions helping you recommend treatment:

a. he lives in high altitude
b. he is using some narcotis
c. he may have heart failure
d. there is some sort of extrapulmonary obstruction
suffers from obstructive sleep apnea
extrapulmonary obstruction: obesity, tonsillar hypertrophy, pharyngeal m collapse on inspiration and nasal septum deviation
treatment can include lose weigth, maintain good sleep hygine (no etoh), sleep with pillows use a CPAP or get a surgical correction of nasal septumj

all the other conditions are causes of central sleep apnea due to cycles of hyper/hypoventilation or Cheyne Stokes breathing due to loss of ventilator effort (brain signal to breath)