316 Exam 2 review including past Quizzes
Alternative quick PaO2 formula
(Fio2% x 7)-(PaCO2 + 10)
Alveolar Gas Equation (PAO2)
(PB - 47) x FIO2 - (PACO2/R) -PB is the barometric pressure, PH2O is the water vapor pressure (usually 47mmHg), FiO2 is the fractional concentration of inspired oxygen, and R is the gas exchange ratio
M. Alkalosis is caused by:
- Causes § Due to increased buffer base or loss of fixed acids, e.g., vomiting (HCl). § Often, it is iatrogenic (relating to illness caused by medical examination or treatment) due to diuretic use or gastric drainage.
Increased Anion gap means:
--Metabolically Produced Acid Gain § Lactic acidosis § Ketoacidosis (can cause Kussmaul Breathing) § Renal failure (e.g., retained sulfuric acid) --Ingestion of Acids § Salicylate (aspirin) intoxication § Methanol (formic acid) § Ethylene glycol (oxalic acid)
Cause of R. Alkalosis
-Alveolar hyperventilation (high RR or high VT) caused by hypoxemia (most common), anxiety, fever, pain
Common causes of R. Acidosis
-Alveolar hypoventilation (ie low RR/ Hypopnea, low VT) --Drug induced CNS depression, neuromuscular disease, obestity, ect.
Adverse effects of bronchoscopy
-Complications few, with mortality <0.01% -Contraindicated if patient has history of bleeding problems. -Possible problems include: -Bleeding, pneumothorax, and infection. -Low-grade fever - 5% of patients. -Prolonged procedure increases risk of hypoxia and hypercapnia
List the positive effects of CPAP therapy for OSA patients
-Decrease EDS and improve neurocognitive testing. -Decrease incidence of pulmonary HTN and right-sided heart failure. -Decrease ventilation-related arousals and nocturnal cardiac events. -Improved daytime oxygenation and ventilation.
How do you generally correct R. Acidosis?
-Improve Alveolar Ventilation (VA). --May include Bronchial hygiene and lung expansion or Intubation and mechanical ventilation
Describe Berlin Questionnaire
-It is a 10 item survey used to identify risk factors associated with sleep apnea. -It has 3 categories -Category 1- Snoring -Category 2- EDS -Category 3- Assessing Blood pressure and BMI -If you qualify for at least 2 out of 3 categories, you should seek treatment for Sleep apnea
Common indications for bronchoscopy
-Masses -Hemoptysis -Pneumonia (trying to determine causative organism) -Interstitial Lung Diseases (Fibrosis, etc) -Foreign Bodies
Clinical signs of R. Alkalosis
-Paresthesia (burning or prickling sensation that is usually felt in the hands, arms, legs, or feet), light-headedness, and dizziness
How does the body compensate for R. Acidosis?
-Renal Reabsorbtion of HCO3 -Renal excretion of hydrogen
How would you diagnose central sleep apnea?
10 sec apnea without respiratory effort during sleep
The definition of sleep apnea uses what criteria for defining an episode of apnea?
10 seconds of not breathing/ apnea
P(A-a)O2 Normal value
10-15
To standardize the placement of electrodes for EEG recording, what system was developed?
10-20 system
Which of the following ratios would result in ph 7.40? -24:1 -10:0.5 -6:0.82 -15:1
10:0.5 because how it relates to the 20:1 compensation rule
What value for the apnea-hypopnea index (AHI) is consistent with moderate obstructive sleep apnea?
15 to 30
CaO2 Normal value
16-20 ml/dl blood
What is the normal value for CaO2?
16-20 vol%
Chronic hypoxemia and anemia effect on 2,3 DPG?
2,3 DPG will increase
In order for our body to maintain a proper ph level, it tries its best to keep the HCO3/(PACO2 x 0.03) ratio at :
20/1
Which of the following AHI scores is moderate sleep apnea? -3 -12 -28 -44
28. A score of 15-30 is considered moderate sleep apnea
Mixed venous oxygen aka PvO2 normal values:
38-42 mm Hg
Normal value of C(a-v)O2
5 ml/dl
An arterial puncture site normally should be compressed for a minimum of ___ minutes after the puncture.
5 to 7. Beware, other sources may say otherwise.
Mild, Moderate, and Severe AHI score
5-15, 15-30, >30
How many questions on a Epworth Sleepiness Scale survey?
8
What score on Epworth Sleepiness Scale means you should seek treatment for EDS?
9 or greater
Normal healthy range for AHI score
<5 AHI score
A practitioner forgets to ice an ABG sample and leaves it at room temperature for 45 minutes. Which of the following parameters can you predict will increase in this sample during that period? I. PCO2 II. pH III. PO2 A.I B.I and II C.II and III D.I, II and III
A. PCO2 will increase
All of the following conditions are associated with untreated obstructive sleep apnea, except: A.systemic hypotension B.pulmonary hypertension C.heart failure D.myocardial infarction
A.systemic hypotension -OSA can lead to increases in pulmonary artery pressure. These increases occur due to the repeating loss of oxygen in the bloodstream due to apneas.
What causes the oxyhemoglobin curve to shift RIGHT?
Acidosis Hypercapnia Fever
What causes the oxyhemoglobin curve to shift LEFT?
Alkalosis Hypocapnea Reduced body temp ie hypothermia Carboxyhemoglobin Fetal hemoglobin
According to CO2 reaction, a drop in 10 mmHg PaCO2 will do what to the HCO3?
HCO3 will decrease by 2
According to CO2 reaction, a rise in 10 mmHg PaCO2 will do what to the HCO3?
HCO3 will increase by 1
20/1 Compensation Formula
HCO3= (PaCO2 x 0.03) x 20
All of the following are symptoms of OSA in adults, EXCEPT: -Morning headaches -Memory loss -Hyperactive behavior -Depression
Hyperactive behavior
What happens to the oxyhemoglobin curve when 2,3-Diphosphoglycerate (DPG) increases?
Increased 2,3-DPG shifts curve to right, promoting O2 unloading
What does knowing the Anion Gap of a patient help you diagnose?
It can help you understand the cause of a patient's Metabolic Acidosis.
Describe polysomnography
It is a overnight study required for definitive diagnosis - Records EEG, EOG, chin EMG, and ECG §Airflow at nose and mouth §Ventilatory effort by piezo belts (chest movement) §Oxygen saturation by pulse oximetry
During Allens test, how long should it take for the hand to regain color after you release the ulnar?
Less than 10-15 seconds
A mixed metabolic acidosis and respiratory alkalosis is likely when the pH and HCO3 are low and the PaCO2 is:
Lower than predicted -Respiratory alkalosis means that the PaCO2 will be lower (<35)
For what condition is the rigid bronchoscope most likely to be used? -.Pneumonia -.Massive hemoptysis -.Tumor -.Interstitial lung disease
Massive hemoptysis
Rigid Bronch Indications.
Massive hemoptysis Foreign Body removal Dilation of airway stenosis Airway stent placement Resection of central airway tumor
Which of the following physical exam findings is NOT associated with obstructive sleep apnea? A.large tonsils B.microcephaly C.macroglossia D.deviated nasal septum
Microcephaly
The arrangement or configuration of the various physiologic tracings on the PSG page or screen is called
Montage
Anion gap normal range and formula
Normal gap is 9-14. Formula= Na - (Cl + HCO3)
How do you correct R. Alkalosis?
Remove stimulus for Hyperventilation. - e.g., treat hypoxemia with oxygen therapy or get patient to breath slower. If patient is intubated, lower the set RR.
Which of the following causes metabolic acidosis? -hyperventilation -renal disease -hypokalemia -vomiting
Renal disease Vomiting would cause metabolic alkalosis, hyperventilation causes respiratory alkalosis
Which stage of sleep involves low amplitude waves and slow eye-roll movement?
Stage 1 NREM
Which stage of sleep has K complexes appear during polysomnography?
Stage 2 NREM
What stage of sleep is known to release growth hormones?
Stage 3 NREM
Which stage of sleep is deep sleep?
Stage 3 NREM
Which stage of sleep shows delta waves? And describe Delta waves.
Stage 3 NREM. Delta waves are high voltage and low frequency waves.
Multiple Wake Test (MWT)
Test of the ability to stay awake
What is the most common indication for the use of a bronchoscope? -.To retrieve inhaled foreign objects -.To obtain microbiologic samples -.To help diagnose abnormalities seen on chest roentgenogram -.To treat hemoptysis
To help diagnose abnormalities seen on chest roentgenogram
What is the primary purpose of bronchoscopy in a patient with pneumonia? -.To obtain biopsy specimens -.To identify the causative organism -.To control hemoptysis D-To remove secretions
To identify the causative organism
For what purpose are lasers used during bronchoscopy?
To obliterate obstructing tumors
Which is NOT the use of the flexible fiberoptic bronchoscope? -.To remove a large amount of blood -.Removal of foreign bodies -.Biopsy of airway and lung tissue -.Inspection of the airways
To remove a large amount of blood
What is the most common cause of low oxygen levels in the arterial blood?
V/Q mismatching
Risk factors for OSA-
Weight BMI >25 Alcohol before bed Smoking Nasal congestion at night Increased neck size Large tonsils Males > or = 40 yr old
In preparation for flexible bronchoscopy, the patient's nostril is numbed with ...?
Xylocaine
Henderson-Hasselbalch equation
[HCO3]/ PaCO2 x 0.03
Indications for arterial blood sampling by percutaneous needle puncture include all of the following except the need to: A.monitor the severity of a disease process B.assess the adequacy of tissue oxygenation C.evaluate ventilation and acid-base status D.evaluate a patient's response to therapy
assess the adequacy of tissue oxygenation
Before an ABG is obtained, the patient's clotting parameters should be evaluated because:
bleeding time may be prolonged if they are abnormal.
What term is used to describe absent inspiratory effort throughout the entire period of absent airflow?
central apnea
Which of the following complaints is frequently seen in a patient with obstructive sleep apnea? A.dizziness B.chest pain C.shortness of breath with exertionD.excessive daytime sleepiness
excessive daytime sleepiness
All of the following parameters are typically monitored with a polysomnogram, except: A.SaO2 B.electroencephalogram (EEG) C.breathing effort D.exhaled PCO2
exhaled PCO2
If a patient's pain or anxiety occurs during arterial puncture, which of the following will probably occur?
hyperventilation
What term is used to describe a significant decrease (a 30% or more) in airflow during sleep but not a complete cessation of breathing?
hypopnea
Which of the following characteristics is not typically associated with sleep apnea? A.male patient B.over the age of 40 years C.hypotensive D.loud snoring during sleep
hypotensive
What is believed to be the cause of systemic hypertension in patients with sleep apnea?
increased sympathetic tone
Fick Equation
Qt = VO2/[C(a - v)O2 x 10]
In which stage of sleep does the brain show electrical activity similar to wakefulness on EEG tracings?
REM
Which stage of sleep has a muscle paralyzing effect which can lead to lower minute ventilations?
REM
What is the primary method of transporting oxygen in the blood?
Bound to hemoglobin
What is considered the first line therapy for OSA?
CPAP
Cheyne Stokes breathing pattern is often seen in what type of apnea?
Central Sleep Apnea
Which of the following describes the correct procedure for an Allen test? A.Compress both the radial and ulnar arteries, then release the radial artery. B.Compress both the radial and ulnar arteries, then release the ulnar artery. C.Compress both the radial and ulnar arteries, then release both arteries at once. D.Compress the brachial artery only and observe circulation to the hand.
Compress both the radial and ulnar arteries, then release the ulnar artery.
Which is a false statement? A.Normal sleep consists of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. B.Each sleep cycle starts with NREM sleep. C.NREM consists of 3 sleep stages: N1, N2, and N3. D.The first cycle starts with N1 which represents deep sleep.
D.The first cycle starts with N1 which represents deep sleep.
Multiple Sleep Latency Test (MSLT)
Diagnostic measurement to access the degree of day time sleepiness and to rule out narcolepsy
Which of the following will assist the RT to measure daytime sleepiness? A.Epworth Sleepiness Scale B.Berlin Questionnaire C.ECG D.A & B
Epworth Sleepiness Scale
What is often the first clinical sign that suggests the presence of hypoxemia?
Exertional dyspnea
Original PaO2 formula
PAO2 = (PB - 47) x FIO2 - (PACO2/R) R is typically 0.8 unless stated otherwise
Describe the "Expected pH" rule/formula
PCO2 decreased by 1 from 40 = ph increased 0.01 Example= PCO2 is 30. PCO2 decreased by 10. The ph 0.01 x 10= 0.1. ph 7.40 + 0.1= 7.50
To get PCO2 off of the 20/1 formula:
PCO2= (HCO3/20) / 0.03
Which of the following represent respiratory component of acid-base status? -PaCO2 -HCO3 -PAO2 -BE
PaCO2
What test can determine the AHI score?
Polysomnography
What test is used to diagnose sleep disorders?
Polysomnography
Identify the indications for blood gas
Presence of significant abnormalities in acid-base status suggested by symptoms, medical Hx, physical exam, or lab data To evaluate ventilation and acid-base status To evaluate a patient's response to therapy To monitor the severity of a disease process
Sleep apnea may cause Right heart failure due to:
Pulmonary hypertension
A pt is breathing 40% O2 and has higher than normal P(A-a)O2, which doesn't improve once pt is given 50%. What is likely cause of hypoxemia?
Pulmonary shunting
Correction of acute respiratory acidosis is accomplished by which of the following? A.increasing HCO3- reabsorption B.increasing alveolar ventilation C.decreasing HCO3- reabsorption D.decreasing alveolar ventilation
increasing alveolar ventilation
Which of the following factors has been shown to positively correlate with obstructive sleep apnea? A.age B.height C.obesity of the upper body D.blood pressure at rest
obesity of the upper body
Normal Anion Gap means:
§ The loss of HCO3 causing a gain of Cl- (reabsorption by the kidney) meaning no change with anion gap. § Also called hyperchloremic acidosis § Gastrointestinal Loss of HCO3− - Diarrhea - Pancreatic fistula § Renal Tubular Loss: Failure to reabsorb HCO3− § Ingestion - Ammonium chloride -Hyperalimentation intravenous nutrition
Medical interventions/treatments for Sleep apnea?
§Positive Airway Pressure Therapy -CPAP Therapy -BiPAP Therapy -Auto CPAP §Oral Appliances- devices that move mandible forward or keep tongue forward. --Weight loss if obese --Avoid alcohol, sedatives, hypnotics --Avoid supine position qSurgical interventions §Palatal Surgery ØUvulopalatopharyngoplasty (UPPP) § Maxillofacial Surgery
Common meds used during bronchoscopy
· 2% Lidocaine for above the vocal cords · 1% topical lidocaine to be used below vocal cords · 0.9% sodium chloride (NaCl) for irrigation. BIGGER container needed if BAL is performed - Appropriate drugs including naloxone (Narcan) and flumazenil (Romazicon) § Flumazenil= benzodiazepine antagonist. used to help you wake up after a surgery or medical procedure in which a benzodiazepine was used as a sedative § Preparation of Fentanyl and Versed (midazolam) for conscious sedation
