Cardiopulmonary Pathophysiology 1 Midterm Review

How can the genetic mutation found with cystic fibrosis (CF) be characterized? 1. There are many variations in the mutation. 2. CF is the most common fatal childhood inherited disorder. 3. The mutation is a dominant trait. 4. The mutation stops ciliary function.

1,2

Signs and symptoms associated with obstructive sleep apnea include: insomnia. excessive daytime sleepiness. hypothyroidism. metabolic alkalosis.

1,2

Which of the following are considered classifications of CFTR mutations? 1. Gating defect 2. Conductance defect 3. Sol layer defect 4. Periciliary defect

1,2

Which of the following are pathologic changes associated with a flail chest? Pneumothorax Secondary pneumonia Pleural effusion Elevated diaphragms

1,2

After open heart surgery, a patient has developed bronchitis with increased secretions and atelectasis. What respiratory therapy procedures should initially be recommended? Chest physical therapy Continuous positive airway pressure (CPAP) Incentive spirometry Inhaled sympathomimetic medication

1,2,3

An iatrogenic pneumothorax may be caused by: positive-pressure mechanical ventilation. pleural biopsy subclavian vein cannulation. endotracheal intubation.

1,2,3

Mixed sleep apnea has which of these traits? Obstructive apnea traits Central apnea traits Usually begins as central apnea Usually ends as central apnea

1,2,3

The respiratory therapist is evaluating a patient for risk for obstructive sleep apnea. Which of the following are risk factors for obstructive sleep apnea? Excess weight Large neck size Hypertension Hypoglycemia

1,2,3

When a person has TB spread throughout the body, it can be found in which of the following locations? Upper lobes of the lungs Kidneys Brain Lower lobes of the lung

1,2,3

Which of the following are identified as opportunistic yeast pathogens? 1. Candida albicans 2. Cryptococcus neoformans 3. Aspergillus 4. Mycoplasma

1,2,3

Cystic fibrosis patients can have: 1. malnutrition. 2. a meconium ileus (bowel obstruction). 3. excessive, viscous pulmonary secretions. 4. a tendency for status asthmaticus.

1,2,3,

Which of the following are precipitating factors for retained secretions that commonly lead to atelectasis? Asthma General anesthesia Gastric aspiration Smoking history

1,2,3,4

Mask CPAP is used with pulmonary edema patients because it: decrease vascular congestion. reduce work of breathing. it is less expensive than mechanical ventilation. improves lung compliance.

1,2,4

Precipitating factors for retained secretions include: decreased mucociliary transport. excessive secretions. overhydration. general anesthesia.

1,2,4

Risk factors predisposing a person to TB include: having HIV/AIDS. being immunosuppressed. African-American or Hispanic heritage. malnutrition.

1,2,4

Which of the following are anatomic alterations that occur when a person has a pneumothorax? The lung on the affected side collapses. The visceral and parietal pleura separate. The visceral pleura adheres to the parietal pleura. The chest wall moves outward.

1,2,4

Which of the following are causes of cardiogenic pulmonary edema? Myocardial infarction Mitral valve disease Allergic reaction to drugs Congenital heart defects

1,2,4

Which of the following can cause pneumonia? Bacteria Viruses Prions Fungi

1,2,4

Which of the following may be used in the management of a patient with central sleep apnea? Acetazolamide Oxygen therapy Inhaled bronchodilator medications Adaptive servo-ventilation (VPAP)

1,2,4

A 40-year-old patient was in a motor vehicle accident. Among his injuries and related problems are three broken ribs on the right side, pleural fluid in the right pleural space, and atelectasis of both lungs. What should be done to help with the atelectasis problem? Adequate pain management Mechanical ventilation to stabilize the broken ribs Remove the pleural fluid Selective intubation of the right mainstem bronchus

1,3

A patient with atelectasis is being monitored by bedside spirometry. What findings would correspond with atelectasis? Decreased IC Increased PEFR Decreased VC Increased DLCO

1,3

Which of the following statements accurately describes the anatomic alterations of the lungs associated with emphysema? 1. It is the weakening and permanent enlargement of the air spaces distal to the terminal bronchioles. 2. It is most closely associated with cystic fibrosis. 3. The distal airways tend to collapse during expiration in response to increased intrapleural pressure. 4. It is characterized by thick secretions and mucus plugging.

1,3

A patient who has an uncontrolled tuberculosis infection will show: weight loss. high fever. bloody sputum. night sweats.

1,3,4

Sleep apnea would be diagnosed in a patient who has which of these findings? More than 15 apnea episodes per hour of sleep. More than 5 apnea episodes per hour over an 8-hour period. More than 75% of the apneas are obstructive. More than 75% of the apneas and hypopneas are obstructive.

1,3,4

The major pathologic or structural changes seen in the lungs with pulmonary edema include: atelectasis. bronchospasm. high surface tension of alveolar fluids. alveolar flooding.

1,3,4

The primary goals of COPD assessment should: 1. include the establishment of the degree of air flow limitation. 2. include the assessment of family members likely to be affected. 3. determine the impact of the COPD on the patient's health status. 4. include retrospective chart examination to determine any missed exacerbations.

1,3,4

Which of the following are considered noncardiogenic causes of increased capillary permeability? Therapeutic lung radiation Cigarette smoke Acute respiratory distress syndrome (ARDS) Inhaled phosgene

1,3,4

Which of the following are found during rapid eye movement sleep? The diaphragm functions normally. The person is easy to awaken. Dreaming occurs. Skeletal muscles are paralyzed.

1,3,4

Which of the following are predisposing factors to aspiration of oropharyngeal secretions and/or gastric contents into the lower respiratory tract? General anesthesia Asthma Seizure disorder Alcohol abuse

1,3,4

Which of the following are risk factors for coronary heart disease? Elevated homocysteine level Elevated vitamin E level Hypertension Diabetes mellitus

1,3,4

Which of the following are precipitating factors that can decrease the patient's ability to generate a negative intrapleural pressure? Supine position Large tidal volume on the mechanical ventilator Malnutrition Obesity

1,3,4 - Vent has to be small tidal volume

A patient with a flail chest is experiencing pendelluft. Which of the following would be expected in a patient with a flail chest with pendelluft? Hypoventilation Hypertension Cyclical deeper and then more shallow breathing Rebreathing dead-space gas

1,4

After gastric bypass surgery, a patient is showing tachypnea. What is the best explanation for this?

Postoperative pain -Postoperative pain will limit the depth of a patient's breath. As a result, the patient breathes faster than normal

Which of the following may be a disadvantage of in-home portable sleep testing?

Published standards for scoring or interpretation

What is the term for an inspiratory fall in systolic blood pressure exceeding 10 mm Hg?

Pulsus paradoxus

A 6-foot-tall, 140-pound, 28-year-old female patient has come to the emergency department with a complaint of a sudden sharp pain in the right upper chest followed by shortness of breath. The pain originated while she participated in deep breathing exercises in a yoga class. The physician has determined that she has a 15% pneumothorax. How should the pneumothorax be classified?

Spontaneous

The rationale behind the use of supplemental oxygen in the treatment of sleep apnea is to:

preoxygenate the airway prior to the apneic episodes.

Ventilator-acquired pneumonia (VAP) is defined as pneumonia that develops: less than 24 hours after mechanical ventilation is started. more than 72 hours after mechanical ventilation is started. more than 48 to 72 hours after endotracheal intubation. between 24 and 48 hours after endotracheal intubation.

more than 48 to 72 hours after endotracheal intubation.

Pulmonary edema produces: obstructive cardiac disease. an obstructive pulmonary disorder. a restrictive pulmonary disorder. both a restrictive and obstructive disorders.

a restrictive pulmonary disorder.

What is the normal hydrostatic pressure in the pulmonary capillaries? 5 to 10 mm Hg Correct! 10 to 15 mm Hg 0 to 5 mm Hg 15 to 20 mm Hg

10 to 15 mm Hg

A patient with cardiogenic pulmonary edema would be expected to have which of the following chest radiograph findings? Depressed diaphragms Pleural effusion Cardiomegaly Bilateral butterfly pattern fluffy infiltrates

2,3,4

If the patient has a tension pneumothorax, which of the following chest radiograph findings would be expected? Elevated diaphragm Mediastinal shift to the unaffected side Increased translucency on the side of the pneumothorax Atelectasis

2,3,4

Severe bronchiectasis is associated with: 1. vesicular breath sounds. 2. cor pulmonale. 3. distended neck veins. 4. polycythemia.

2,3,4

Which of the following are clinical findings associated with chronic bronchitis? 1. Fever 2. Purulent sputum 3. Right heart failure 4. Elevated CO2 level

2,3,4

Which of the following are commonly cultured from the mucus in the tracheobronchial tree of a patient with cystic fibrosis? 1. Klebsiella 2. Pseudomonas aeruginosa 3. Haemophilus influenzae 4. Staphylococcus aureus

2,3,4

Which of the following may be causes of cardiogenic pulmonary edema? Pulmonary embolism Dysrhythmias Systemic hypertension Excessive fluid administration

2,3,4

Which of the following would be recommended for the management of an adult with a severe flail chest? Continuous positive airway pressure (CPAP) Pain management Mechanical ventilation Positive end-expiratory pressure (PEEP)

2,3,4

When a patient has pneumonia, which of the following would be found in the alveolar effusion fluids? Mucus Macrophages Saliva Red blood cells

2,4

Clinical disorders associated with central sleep apnea include: Pickwickian syndrome. depression. encephalitis. brain stem infarction.

3,4

Which of the following pulmonary function testing values would be found in a patient with severe, obstructive bronchiectasis? 1. Decreased RV/TLC ratio 2. Increased PEFR 3. Increased FEF25%-75% 4. Decreased FEF25%-75%

4

According to GOLD, at what age can the initial diagnosis of COPD be made?

40 years

Cystic fibrosis is a gene disorder caused by mutations in a pair of genes located on chromosome

7

After the inhalation of a bronchodilator, what percentage change in peak expiratory flow (PEFR) would be required to demonstrate reversible air flow limitation consistent with asthma?

>20%

If the mouth and nose are closed at the peak of a complete inspiration, but before expiration, and the breath is held, what is the pressure of gases within the alveoli relative to the pressure of atmospheric air?

Alveolar pressure is greater than the pressure of atmospheric air

The respiratory therapist is asked to evaluate a patient with suspected congestive heart failure. Which of the following laboratory tests should the respiratory therapist recommend to evaluate the patient for possible congestive heart failure?

Brain natriuretic peptide (BNP)

The partial pressures of carbon dioxide (pCO2) and oxygen (pO2) in the atmosphere at sea level are 0.3 mmHg and 160 mmHg respectively, but the partial pressures of these gases in the blood leaving the lungs are 40 mmHg (pCO2)and 95 mmHg (pO2). What factor most likely accounts for this difference?

CO2 is more soluble in the blood than O2

Which of the following conditions is least likely to lead to atelectasis?

Chronic obstructive pulmonary disease (COPD

According to the GOLD report, which of the following is the greatest worldwide risk factor for COPD?

Cigarette Smoking

Rigid and dilated bronchi are the key anatomic alterations found in which type of bronchiectasis?

Cylindrical

Which of the following is true of the diffusing capacity test (DLCO) findings in a patient with COPD?

Decreased in emphysema

interstitial lung disease (ILD) refers to a set of conditions which affect the pulmonary interstitium-- the area of tissue and space which lies between the alveoli and alveolar capillaries. What factor in the setting of severe ILD, would NOT decrease the extent to which oxygen passes from the air sacs of the lungs into the blood?

Decreased interstitial thickness

What is the primary cause of hypotension in a patient with a large pneumothorax?

Decreased venous return to the heart

Which of the following accurately describes a flail chest?

Double fractures of three adjacent ribs

What produces the force which drives normal exhalation, and is the process active or passive?

Elastic force, passive

The development of immediate postoperative atelectasis is commonly related to which of the following?

Excessive bronchial secretions

The physician asks you to suggest an inhaled corticosteroid for a patient with asthma. Which of the following medications are appropriate?

Flovent HFA

How many components of care are included in the NAEPP asthma management guidelines?

Four

In the Midwestern part of the United States, what is the most common fungal infection of the lungs? Cryptococcosis Histoplasmosis Coccidioidomycosis Blastomycosis

Histoplasmosis

Many respiratory diseases affect pulmonary function by altering the ability of alveoli to participate in gas exchange. What physical change would most greatly reduce the degree to which a particular alveolus is ventilated?

Increased alveolar elastic recoil

After surgery, a patient must lie supine in bed. Because of this, atelectasis is thought to have developed. What chest radiograph finding would confirm this?

Increased density in both posterior lower lobe areas

What is the pressure of gas within the alveoli at the peak of inspiration, just before expiration, relative to that of atmospheric air?

The same as atmospheric air

Which of the following chest assessment findings would be expected in a patient with a tension pneumothorax? a. Decreased thoracic volume on the affected side b. Dull percussion note c. Tracheal shift away from the affected side d. Wheezes

c

In developed countries, the most common cause of acquired bronchiectasis is:

cystic fibrosis

A CPAP titration polysomnogram is performed to:

find the CPAP level to maintain an open airway.

The preferred imaging method to diagnose a patient's with noncystic fibrosis bronchiectasis is:

high-resolution computed tomography (HR-CT)

A medication used to treat a TB infection during the entire 9 months of the nine-month treatment protocol are:

isoniazid and rifampin. -Isoniazid (INH) and rifampin (Rifadin) are first-line agents prescribed for the entire 9 months. Isoniazid is considered to be the most effective first-line antituberculosis agent.