Entire Hank Bank
What is the appropriate neonatal dosage of Narcan?
0.01 mg/kg
Expressed as mg/kg, what is the dosage range for nebulized atropine?
0.0125 to 0.075 mg/kg (Q4 to Q6)
It is estimated that what % of all hospitalized patients develop nosocomial pneumonia?
0.5 to 5%
What is the solubility coefficient of carbon dioxide?
0.510 ml/ml plasma at 37C and 760 mmHg
During administration of an aerosol, a 15 second breath hold allows for maximal deposition of particles smaller than what size?
0.5micrometers
Cuffed ETT are how much larger in external diameter than uncuffed tubes?
0.5mm
In patients with a simple metabolic alkalosis, how much will the PaCO2 increase for each mEq increase in bicarbonate?
0.6 torr
In the single-breath DLCO test, what is the "standard" volume of dead-space washout volume which should be exhaled before the alveolar sampling begins?
0.75 to 1.00 L
What is the fractional concentration and partial pressure of nitrogen in dry atmospheric gas at sea level?
0.7808, 593 mmHg (0.7808 x 760)
According to Egan, what size of aerosol particles are targeted to the lung parenchyma?
0.8-2.0 micrometers
Laryngeal incompetence and aspiration is observed in what percent of patients in the immediate post-extubation period?
50% (decreases to < 5% after 8 hours, 20% of all extubated patients require re-intubation)
What percent of men and women, respectively snore?
50% and 25% (only 4% & 2% have sleep apnea)
According to P & K, what is the incidence of PTE in the U.S.?
500,000 yearly, 50,000 die (incidence of DVT - 5,000,000 yearly, only 50% develop physical signs)
What is the range of reported depression among COPD patients?
51-74% (anxiety is reported in up to 90% of COPD patients)
In order to meet minimal spirometry standards, what range and accuracy must an instrument measuring FEF25-75% have?
7 L plus or minus 5% or 0.2 L/sec, whichever is greater
In humans, hypoxia probably occurs when PO2 is less than what value in the mitochondria?
7 mmHg
An apgar score of what value indicates the need for minimal intervention?
7 or more
According to Kacmarek, how many Americans require long-term mechanical ventilation support?
7,000
Freon propellants used in MDI's are labeled 11,12,and 114. What specific name is any of these three known by?
11 - trichloromonoflouromethane, 12 - dichlorodiflouromethane, 114 - dichlorotetraflouromethane
What is the typical hemoglobin level of a three month old infant?
11 gm/100ml
What were the total expenditures for home health care in 1991?
11.1 billion
In 1989, how many people in the U.S. reported that they had asthma?
11.6 million (12 million with chronic bronchitis, 2 million with emphysema)
Work loads greater than what value are associated with failure of weaning trials?
12 J/min
According to Kacmarek, at what flow rate should viscous antibiotics be nebulized when using gas-powered small volume nebulizers?
12 L/min
On an MVV test, what is the minimum length of time that the tracing should show a continuous, rhythmic effort?
12 seconds
On the average, how long does it take between a drug identified as a promising potential drug and that drug fully approved by the FDA?
12 years (1/10,000 chemicals, cost of 200 million)
The average nasal resistance of infants is what?
13 cmH2O/L/sec
What is the outer diameter of the Combitube?
13 mm
On the Bear 3, what is the minimum flow that can be used with the tapered flow pattern?
20 L/min (min flow is 10%)
What is the maximum pressure that nasal CPAP or BiPAP units are capable of generating?
20 cmH2O
What is the average depth of nasal ET tube insertion from the external naris for adult males, according to Egan?
25 cm (23 cm for females)
The consensus appears that flow-triggering reduces response time by approximately what percent compared to pressure-triggering?
25%
What is the usual CO value for a one-pack-per day smoker?
25-30 ppm
Individuals with normal lungs can tolerate an increase of what percent in airway resistance before they will report dyspnea?
25-30% (drop of 10-15% in compliance = dyspnea)
What is the amount of gaseous oxygen which will evaporate from a LOX system in 12 hours when it is not being used?
250 L/12 hours
What is the barometric pressure on Mt. Everest?
253 mmHg (PIO2 = 43 mmHg)
The Respironics Pressure Easy maintains cuff pressures below what value?
27 cmH2O
When pentamidine is administered via an intramuscular route, how long does it still continue to be excreted in the urine?
270 days
What percent of patients with acute abdominal pain require surgical intervention?
75%
Of what two materials is a typical half-cell composed?
A metal and a solution of that metal's salt (e.g. silver and silver chloride, mercury and mercurous chloride)
According to Chatburn, what term is defined as a particular set of control variables, phase variables, and conditional variables
A mode of ventilation
According to Egan, where is the isothermal saturation boundary located in respect to airway anatomy?
About 5 cm below the carina at the level of the third generation airways (will shift distally with decreased temp., humidity, mouth breathing, increased VT)
At what age is red bone marrow of long bones replaced with less vascular yellow marrow?
About 5 years (distal tibia most commonly used in adults for IO infusion)
What percent of cardiac victims in the field can be managed with oropharyngeal airway, headtilt, and bag mask ventilation?
About 70%
Name any two advantages of MRI over CAT scanning?
Absence of ionizing radiation, no need for injection of contrast materials, ability to produce sagital and coronal views
What pressure would you obtain if you added gauge pressure and atmospheric pressure?
Absolute pressure
Oxygen toxicity is associated with a decrease in vital capacity. What is the most probable mechanism for this decrease?
Absorption atelectasis
In the pharmacokinetic phase, what are the four major factors that control the amount of a drug in the body?
Absorption, distribution, metabolism, elimination (also can include protein binding)
What is the most commonly used form of asbestos used in North America?
Chrysotile
The Ck isoenzyme that occurs in the brain is made up of 2 similar subunits and is referred to as what?
Ck-BB
What are the major anions in extracellular fluid?
Cl- and HCO3-
By what other name may ionic bonds be called?
Electrovalent
MMV first appeared on what ventilator?
Engstrom Erica
Pressure support ventilation first appeared as "inspiratory assist" on what ventilator in 1981?
Engstrom Erica
What is Avagadro's law?
Equal volumes of gases at the same temperature and pressure contain the same number of molecules. Weights of atoms in grams corresponding to atomic weight, and weights of molecules in grams corresponding to molecular weight contain the same number of particles.
In the metric system (or CGS system) what is the unit used to measure work?
Erg (1 Erg = 1 dyne x 1 cm)
Medicare will reimburse for oxygen therapy when the primary diagnosis is chronic lung disease and the PaO2 less than or equal to 55 mmHg. What secondary conditions allow Medicare reimbursement at PaO2 of 56 to 59 mmHg?
Erythrocytosis, congestive heart failure, cor pulmonale
What is an ETC and how does it work?
Esophageal Tracheal Combitube - a double lumen tube that allows for ventilation whether it is placed in the trachea or the esophagus
What three mechanisms account for most serious airway complications when intubation is attempted?
Esophageal intubation, failure to ventilate, difficult intubation
Name two modifications of the esophageal obturator designed for pre-hospital use.
Esophagotracheal combitube (ETC), Pharyngotracheal lumen airway (PTLP)
The pro-drug, bitolterol, is metabolized by what enzyme?
Ester
What term denoted the escape of a liquid's molecules at the surface of the liquid into the atmosphere?
Evaporation
An elevated body temperature is seen in what four types of disorders?
Fever, environmental heat illness, malignant hyperthermia, neuroleptic malignant syndrome
When do Ck levels rise following and MI?
First 8 hours and persist for several days
What is the composition of the sieve beds of the molecular sieve O2 concentrator?
Grandular zeolite crystals (they contain a network of 5 Å diameter holes that allow traces of O2 and argon to pass through as they are pressurized to 10-30 psi)
Devices used to measure pressure can be classified into what three categories?
Gravity-dependent fluid manometers, mechanical aneroid manometers, electro-mechanical transducers
Name 2 theoretical advantages of the Circulaire nebulizer.
Greater efficiency while minimizing deposition in the GI tract, less aerosol release into the environment
Inertial impaction removes particles greater than what diameter in the upper airway?
Greater than 10 to 20 microns
What group of streptococci are common in the oropharynx and seem to cause pneumonia in debilitated patients who are elderly, diabetic, receiving corticosteroid therapy, or afflicted with chronic renal failure or malignancies?
Group A (S. pyogenes) (note: group B = S. agalactiae, both are gram positive cocci in chains)
What is the difference between the Guedel and Berman oropharyngeal airways?
Guedel has a single center channel, Berman has two parallel side channels
What is the most common peripheral polyneuropathy that results in hypoventilation?
Guillain-Barre syndrome (CSN = increased protein, few cells)
If, on a single individual, you were to use a Harris-Benedict Equation to predict an REE and also measure REE by indirect calorimetry, what would you probably find when the two REE's were compared?
HBE underestimates the REE by up to 40%
According to Branson, what is the most popular type of artificial nose?
HCH
What kind of an analyzer is used to measure carbon monoxide during a single-breath diffusion test?
Infrared analyzer
Specifically, what is the mechanism of action of indomethocin?
Inhibitor of cyclo-oxygenase
What is the mechanism of action of Zileuton (Zyflo)?
Inhibits the 5-lipoxegenase enzyme (thus prevents the formation of leukotrienes from arachidonic acid)
Bronchodilator activity of isoethrane is only 1/10 that of isoproterenol. How do the two drugs compare with regard to cardiovascular activity?
Isoethrane is only 1/300 the activity of isoproterenol
Based on chemical structure, what two families can the non-depolarizing muscle relaxants be divided into?
Isoquinolone, Steroid
What is the proper name for the 4 or 5 L glass bottle filled with metal wool that is used for quality control of a body plethysmograph?
Isothermal volume analog (function of metal wool is to act as a heat sink)
Describe the Bardex Airway.
It has a large flange at the nasal end and a bevel at the pharyngeal end
What happens to the respiratory exchange ratio with exercise?
It increases from 0.7 to 1.0 (with severe exercise when lactic acid is produced, the RQ>1 because the lactic acid + HCO3- > lactate + CO2 without additional oxygen usage)
What is the effect of fever on respiratory tract insensible water loss?
It increases water loss
What is a laryngeal web?
It is a "membrane" that forms in the glottic area as a result of necrotic tissue forming fibrin and cellular debris
What is the mechanism of action of Zafirlukast (Accolate)?
It is a leukotriene receptor antagonist (competitive inhibitor of LTD4 and LTE4)
What two concepts are central to quality assurance?
Accuracy (extent to which measurement of a known quantity results in a value approximately that quantity) & precision (extent to which repeated measurements of the same quantity can be reproduced)
During exercise or metabolic testing, the accuracy of the test depends on what two accuracies?
Accuracy of the volume transducer, accuracy of the gas analyzers
According to P & K, what two drugs are effective in reducing the incidence of acute mountain sickness?
Acetazolamide, Dexamethasone
The highest level of AST occurs in what disease?
Acute Hepatitis
When do moderate elevations of LDH occur and how long do they last?
Acute MI beginning at 24 hours after infarction and lasting up to 2 weeks
What are 3 symptoms of malignant hyperthermia?
Acute muscle rigidity, cardiovascular instability, hypermetabolism, rapidly rising body temp. (1C/5 min.). (MH is due to sudden massive release of Ca from the muscles in genetically susceptible individuals on exposure to triggering agent)
Chemically, what is the nature of the molecule pentamadine?
An aromatic diamidine (first synthesized in 1937 - used to treat African sleeping sickness, trypanosomiasis, leishmaniasis, pneumocystosis, and babesiosis - caused by an erythrocytic protozoan parasite)
Psychoactive drugs generally fall into what three categories?
Anxiolytics, Hypnotics, Antidepressants
Define the term "drug".
Any chemical that alters the an organism's functions or processes
Who should be considered a candidate for a pulmonary rehabilitation program?
Any patient with stable chronic respiratory disease who is symptomatic and experiences dyspnea on exertion (candidates must be free of acute illness and motivated to lead a more active life)
According to Danztker, what percent of healthy subjects aspirate during sleep?
Approximately 70%
Calculations of gas density are based upon what law?
Avogadro's law
Name the 3 alternatives to nasal CPAP or surgery in the treatment of OSA.
Behavioral (weight reduction), medical-pharmacologic (oxygen), mechanical (oral appliances, nasal splints)
What are the 4 treatment options for sleep apnea patients?
Behavioral approaches, nasal CPAP, oral/dental devices, surgical procedures
Dr. Tom Petty has published a list of ethical principles. Name any three.
Beneficence, autonomy, informed consent, advanced directives, substituted judgment, patient'' best interests, reason
Who, in 1969, analyzed the exhalation of anesthetized subjects and developed an equation that described the time course of passive exhalation?
Bergman (Vt = Voe - (1/RC)t)
In contrast to beta-adrenergic receptors location, where are cholinergic receptors most numerous?
Beta-adrenergic receptors have their greatest density in bronchioles where as cholinergic receptors are numerous in proximal bronchial smooth muscle but rare in distal bronchioles
Q: What do you call direct vascular connections between bronchial and pulmonary arteries?
A: Bronchopulmonary arterial anastomoses (as a consequence, the interruption of the bronchial circulation during lung transplantation can be compensated for by collateral route from the pulmonary arteries)
Q: The upper respiratory tract consists of the nasal and oral cavities, the pharynx, and the larynx. What are the four important functions that the upper respiratory tract performs?
A: Conducts respiratory gases, defense mechanism for the lungs, humidify inspired gases, heat exchange
Q: What are the three major layers of the tracheobronchial wall?
A: Epithelial lining, laminar propria, cartilagenous layer
Q: What minute ventilation increase would someone have to have to reduce his PCO2 from 40 torr to 8 torr?
A: Five fold increase in VA
Q: Carbonic anhydrase is located in the RBC and as a result of its presence, large quantities of HCO3 are produced there, most of which diffuses into the plasma. What colorful term describes the movement of the Cl- into the RBC to maintain electrostatic equilibrium?
A: Hamburger phenomenon
Q: The epiglottis is attached anteriorly to the hyoid bone by what ligament?
A: Hyoepiglottic ligament
Q: How much of the total 42 liters of body water is in the form of intracellular fluid and how much is in extracellular fluid?
A: ICF = 2/3 or 28 L, ECF = 1/3 or 14 L
Q: What are the two reasons why the diffusing capacity of the lung increases during exercise?
A: Increase in diffusing capacity of the membrane (known as DM), increase in volume of blood in the capillaries (known as VC); (1/DL = 1/DM + 1/VC)
Q: Describe what the term "recruitment of capillaries" does to overall pulmonary vascular resistance.
A: It lowers PVR by involving more capillaries in circulation
Q: A patient's ventilatory demand is primarily determined by what three factors?
A: Metabolic rate (CO2 production), CNS drive, ventilatory deadspace
Q: What is transairway pressure?
A: Mouth pressure - alveolar pressure
Q: What is the transpulmonary pressure?
A: Mouth pressure - intrapleural pressure
Q: To distinguish it from the osmotic pressure generated by electrolytes, what is the pressure called that is exerted by albumin and other macromolecules?
A: Oncotic pressure
Q: What is the origin and insertion of the scalene muscles?
A: Origin - transverse process of C2 - C6, insertion - 1st and 2nd ribs
Q: Name three possible mechanisms that cause airways to constrict.
A: Parasympathetic (cholinergic) stimulation, alpha-sympathetic stimulation, beta-receptor blockade
Q: What controls Ca+ levels in serum?
A: Parathyroid hormone (PTH) and vitamin D
Q: What enzyme acts on membrane-bound phospholipid to produce arachidonic acid?
A: Phospholipase A2
Q: What nerve provides the primary motor innervation to the larynx?
A: Recurrent laryngeal nerve - branch of the vagus (superior laryngeal nerve, or external branch, supplies the cricothyroid muscle. Internal branch supplies sensory fibers to the larynx)
Q: Give two other terms that have the same meaning as the term "Starling resistor".
A: Sluice and Waterfall effect
Q: The pulmonary lymphatic system has been subdivided into two parts on the basis of location, the superficial plexus and the deep plexus. Where are each of the subdivisions located?
A: Superficial plexus is in the visceral pleura, deep plexus is in the connective tissue surrounding the airways and blood vessels of the lung
Q: What is the meaning of the acronym SOD? (it's and enzyme)
A: Superoxide dismutase
Q: What organ is first affected by altitude sickness?
A: The brain
Q: What is the term for the area where the trachea bifurcates into left and right mainstem bronchi?
A: The carina
Q: What are the two major portions of the diaphragm?
A: The costal portion (lower six ribs), the crural portion (upper lumbar vertebra)
Q: What is the anion gap?
A: The difference between the commonly measured cations and anions
Q: Normal subjects who are born and remain at high altitude exhibit what pulmonary vascular resistance?
A: Twice that of age-matched sea level residents
Q: What percent of bradykinin is inactivated by passage through the lung?
A: Up to 80% ( serotonin & norepinephrine are inactivated but not by enzymes - uptake and storage - then released during anaphylaxis)
What is a liver enzyme that is elevated in hepatic disease similarly to AST?
ALT - alanine amino transferase
According to P & K, BiPAP can be defined as being similar to what other mode of ventilation?
APRV
What typed of drug therapies do APTT and PT monitor?
APTT - Heparin, PT - Warfarin (Coumadin)
In the adult, the volume of anatomic deadspace may be estimated to be about 1 ml/lb. What is the corresponding value for neonates?
About 1 ml/lb
What proportion of all lung cancers are of the squamous type?
About 1/3 (adenocarcinoma also 1/3 - most common lung cancer in women)
A rescuer delivering mouth to mask ventilation while wearing a nasal cannula at 8-10 L/min would deliver what FIO2 to the patient?
About 30%
What percent of children born to HIV infected women are also infected?
About 30% (breast feeding increases this percent postnatally)
What pressure would a diver experience at a depth of 100 feet?
About 4 atm or 3,040 mmHg
To what percent of vital capacity does amniotic fluid fill the fetal lung?
About 40%
What effect does an increased FRC have on work of breathing?
It is increased
The transfer of carbon dioxide is said to be diffusion limited. What can be said of the transfer of nitrous oxide?
It is perfusion limited (oxygen is perfusion limited usually, but when pathology impairs diffusion properties, oxygen can become diffusion limited)
How is FEV1/FVC useful in pulmonary function testing?
It separates patients with airway obstruction from those with normal pulmonary function and from those with restrictive impairment
What is geometric standard deviation?
It states the variability of particle size within an aerosol
What principle states that when gases under pressure are released into a vacuum, the gas molecules will tend to lose their kinetic energy?
Joule - Kelvin principle
A solution of what salt acts as the "liquid junction" separating blood from the calomel electrode in a pH electrode?
KCL
What is the formula that describes kinetic energy?
KE - ½ mv2
If you were to see on an x-ray of the chest, lines representing distention and thickening of lymphatic vessels accompanying the pulmonary arteries and veins, what would you call these lines?
Kerley "A" lines (Kerley "B" lines are the radiologic manifestation of distended lymph vessels in the interlobular septa)
What does APTT measure and what is the normal value?
Length of time required for plasma to form a fibrin clot, 24-32 seconds
What is an advantage of the Cole pediatric tube?
Less airway resistance to airflow than that for a tube that is of the same diameter as the tip
In patients with full blown AIDS, how many T4-lymphocytes are present in each mm3?
Less than 100
What is the name of the protein which is induced by corticosteroids and inhibits phospholipase A2?
Lipocortin (other genes in the glucocorticoid response elements(GRE) include lipocortin, neutral endopeptidase, secretory leukocyte protease inhibitor(SLPI), and inhibitor of plasminogen activator)
What is the name of the clinical entity associated with the aspiration of mineral oil?
Lipoid pneumonia
What do you call the state of matter in which the Van der Waal's forces are not strong enough to maintain a shape, but are strong enough to maintain a volume?
Liquid
List 5 factors that decrease the metabolism of theophylline by the liver.
Liver disease, CHF, cimetidine, cor pulmonale, severe exacerbation COPD
What four factors determine the development of silicosis?
Particle size, concentration of particles, duration of exposure, individual susceptibility
The observation that pressure in a liquid acts equally in all directions is a concept known as whose principle?
Pascal's principle
How is profit usually computed?
Percent of return on the capital invested
What are the names of the five different nitrogenous bases that occur in DNA and RNA?
Pyrimidines - uracil, thymine, cytosine; Purines - adenine, guanine
What term defines the amount of a substance present in the respiratory tract at a given point in time?
Retention (clearance - removal of a deposited aerosol that is not soluble in a mucus membrane)
What is presumed to be the basic cause of transient tachypnea of the newborn?
Retention of fetal lung fluid
According to the AARC CPGs, what are 3 uses of fiberoptic bronchoscopy?
Retrieval of tissue specimens, cell washings (BAL), removal of abnormal tissue by laser
What do you call an experimental study in which data is collected from information that has been already available before the study was designed?
Retrospective study (Prospective study - data collected after the study was designed)
According to Egan, list 6 clinical objectives of ventilatory support.
Reverse hypoxemia, reverse acute respiratory acidosis, relieve resp. distress, prevent or reverse atelectasis, reverse ventilatory muscle fatigue, permit sedation and/or neuromuscular blockage, decrease systemic or myocardial O2 consumption, reduce ICP, or to stabilize the chest
Several proportional devices together used to provide a device for sensing minute pressure changes between C1 & C2 to cause outputs of O1 & O2 of a fluidic device is called what?
Schmitt trigger
What is the major difference between the Solosphere, Hydrosphere, and the Maxicol nebulizers?
Solosphere has a single sphere (flow - 15-63 L/m), the Hydrosphere (flow 15-135 L/m) and Maxicol (flow 30-257 L/m) both use two spheres. All have entrainment capabilities, MMAD about 4 micrometers
Name the 3 models (brands) of Babbington nebulizers produced in the U.S.
Solosphere, Hydrosphere, Maxicol (none are currently being produced)
What term denoted the amount of gas that can be dissolved by 1 ml of a given liquid at standard pressure and specified temperature?
Solubility coefficient
Name any two of the neuropeptides released from non-adrenergic non-cholinergic sensory C-fiber nerve endings.
Substance P, Neurokinin A, Neurokinin B (Neutral endopeptidase, NEP, inactivated these three neuropeptides)
In addition to bulk flow, name the four mechanisms by which gas transport occurs during high frequency jet or oscillator tidal breaths.
Taylor dispersion, coaxial flow, pendelluft, augmented molecular diffusion
What are the four basic variables which affect gas volumetric relationships?
Temp, pressure, volume, relative mass
The amount of water vapor that a given volume of air can hold is dependent on what two factors?
Temperature, water availability
The double lumen endotracheal tube produced by National Catheter Corporation is called what?
The Broncho Cath
According to Ruppel, what is the explanation for the lack of effect on pH when excessive heparin is mixed with blood in a blood gas syringe?
The large buffering capacity of whole blood prevents changes in pH
On a flow-volume loop, what is meant by the Vmax50 (V dot max 50)?
This is the flowrate observed when one-half of the vital capacity has been exhaled
Name two products of the cyclo-oxygenase pathway that increase vascular tone and pulmonary smooth muscle tone.
Thromboxane A2 and PGF2Alpha (Thromboxane A2 also results in inflammation)
What term defines the softening of the cartilaginous rings, which causes collapse of the trachea on inspiration?
Tracheomalacia
How would flow-volume loops be useful in distinguishing between tracheomalacia and tracheal stenosis?
Tracheomalacia - variable obstruction with different inspiratory and expiratory patterns; tracheal stenosis - fixed obstructive pattern with flattened inspiratory and expiratory limbs
What is TENS?
Transcutaneous Electrical Nerve Stimulation
Regarding infectious disease transmission, what is "vectorborne"?
Transmission via ticks, mites, mosquitoes, or fleas
What are 3 classifications of pneumothorax?
Traumatic, iatrogenic, spontaneous
What term describes the breakdown of laminar flow in which there is random interaction between fluid molecules and friction resulting not only from the sides of the tube but also from molecular collision?
Turbulent flow
What is O2 pulse?
VO2/HR - an indirect measurement of stroke volume
What is the difference between the pressure regulated volume control and volume support modes on the Servo 300?
VS breaths are all patient triggered
The "crop" index has been used to predict success or failure in weaning patients from mechanical ventilation. When calculating this value, in what units of measure is the resulting value reported?
mL/breath/min (>13 predicts success)
In what units is diffusing capacity expressed?
mL/min/mmHg
Hemoglobin F may normally be present for how long following birth?
up to 1 year
What highly cytotoxic product results when nitric oxide free radicals react with superoxide anions?
peroxynitrite radicals (OONO-) - may oxidize as sulfhydryl groups in proteins
According to P & K, what is the accuracy range of pulse oximeters at saturations > 70%?
plus or minus 4% ( plus or minus 6% < 70%)
How many Americans dying from cancer die from bronchogenic carcinoma?
¼
What is the approximate time needed for complete equilibration of O2 and CO2 between alveolar gas and capillary blood in one red blood cell?
¾ of a second
Of cardiac patients who receive advice to quit cigarette smoking after an acute event, what percent do so?
45% (rate increases to 72% if advice is coupled with 2 hours of education in relapse prevention)
What percent body humidity is provided by large volume nebulizers?
58-74% cold, 75-96% when heated
What percent of cirrhotic patients who develop ascites survive the first year?
59%
What percent of adults who have AIDS develop Pneumocystis carinii pneumonia?
60-80% (39% of children)
P & K recommend what peak flow setting in most spontaneously breathing patients to minimize the work performed by the patient during volume-assisted breaths?
60-90 L/min
To minimize the WOB with patients receiving mechanical ventilation, P & K recommend what set flow rate range to be used with spontaneously breathing patients?
60-90 L/min (or TI of 0.8 - 1.2 seconds, square or sine waveforms)
Worldwide, how many deaths occur per year as a result of failed intubation attempts?
600
What is the ASTM recommended minimum delivered tidal volume for adult resuscitators?
600 mL (70-300 mL - child, 20-70 mL - infant; AHA - 800 mL)
With the "triflow II" incentive spirometer, what inspiratory flow is required to raise the first ball?
600 mL/sec (900 ml/sec 1+2, 1200 ml/sec 1+2+3 balls)
Within a pH electrode, how much voltage difference between the reference and working solution is present for each pH unit difference?
61.5 mv
What is the absorbance peak of sulfhemoglobin?
618 nm (met Hb = 630 nm)
After a thrombus has formed, how long does it take for the body's natural fibrinolytic system to dissolve it?
7-10 days
In early gestation (prior to 26-28 weeks), only about 3% of the cardiac output enters the lung. How much of the cardiac output perfuses the lung at term?
7-10%
How many people in the U.S. are estimated to meet the minimum criteria for obstructive sleep apnea-hypopnea?
7-18 million (1.8-4 million with AHI > 15 - severe illness)
What percent of the spray from most MDI's consists of the active drug?
1% (60-80% by weight are chloroflourocarbons)
In what year was the PB7200 introduced?
1983 (7200a - 1985, memory expansion over 7200; 7200sp - 1988, 7200a with memory upgrade)
According to the AARC clinical practice guidelines, what dilution of epinephrine should be available as a vasoconstrictor to control bleeding during bronchoscopy?
1:10,000
with reference to alpha1-antitrypsin deficiency, what is the estimated incidence?
1:3,500 to 1:1,670 (one of the most common serious genetic conditions)
What is the difference between primary, secondary, and tertiary prevention?
1degrees - no evidence of disease, decrease risky behavior; 2degrees - disease present but symptoms not readily apparent; 3degrees - patient already has established disease with symptoms, pulmonary rehab. Program
What is the usual size of a silicotic nodule?
2-3 mm in diameter (mostly in upper lungs and perihilar regions)
The pneumococcal vaccine enhances antibody production against how many capsular serotypes?
23
How long after the start of a necrotic or infectious process do macrophages show up in the affected tissues?
2-4 days
What is the most sensitive test in screening for diabetes?
2-hour post-prandial
What is the mass median diameter particle size of a Proventil MDI?
2.4micrometers (alupent - 4.8, metaprel - 3.5, beclovent - 3.9, azmacort - 4.0; pneumatic jet: Airshields - 6.0, RespirGard II - 0.76, SPAG - 6.8, measured in dry air)
What is the sedimentation rate and the Brownian movement of a 5 micrometers particle in sill air?
2.5 micrometers/sec, 1550 micrometers/sec
What internal diameter is the appropriate ETT size for a 500-1000 gm infant?
2.5 mm
When performing a single-breath DLCO test, how long should it take for inspiration from RV to TLC in normal and obstructed patients respectively?
2.5 seconds for normal and less than 4 seconds in obstructed patients
The development of the respiratory structures begins by what gestational day?
24 days
Before a single-breath DLCO test, how long should a patient refrain from smoking?
24 hours
How many hours of glucose supply is contained in the liver's store of glycogen?
24 hours
The relapse rates for heroin, alcohol, and smoking are virtually identical. What proportion of individuals treated resume the habit within 3 months?
2/3
What is the survival rate of trach patients who develop tracheoinnominate artery rupture?
25%
What percent of a drug is wasted in the environment during continuous nebulization with a normal I:E of 1:3?
25%
What percent of lung cancers are considered operable at the time of diagnosis?
25%
What percent of resectable lung cancer cases live 5 years or longer after surgery?
25% (of the 25% of total cases that are considered operable)
In ml/kg body weight, what is the FRC of a newborn?
25-30 ml/kg (VT 4-6 ml/kg)
Under normal conditions, how much water and heat are lost from the lungs each day?
250 mL of water, 1470 J of heat
Wheezes are defined as continuous sounds that are longer than what duration?
250 ms
What is the largest decimal number that can be represented by one byte?
256 (one byte = 8 bits; to work with large numbers, current computers use registers that handle 32 or 64 bits at one time)
At what gestational age do the right and left pulmonary arteries start to develop?
26 days
What is the average yearly loss in FEV1 for healthy men and women?
30 mL/yr in men, 23 mL/yr in women (15-20% of smokers may lose 60-80 mL/yr)
What is the minimum water output level for heated humidifiers as recommended by ANSI?
30 mg/L (100% RH at 30 degrees C)
In men averaging 70 years of age, what is the observed clearance rate of theophylline?
30 mg/kg/hr
Postural drainage is not helpful for patients with COPD unless the individual produces how much sputum per day?
30 ml (1 ounce)
What is the normal PO2 of fetal blood leaving the placenta in the umbilical vein?
30 mmHg
At 8,000 feet, gas density changes approximately how much lower than sea level?
30%
What is the reported incidence of tracheal granulomas?
30% (10% of patient's go on to demonstrate chronic changes associated with tracheal stenosis)
Smoking accounts for what % of all cancer deaths?
30% (87% of all lung CA deaths; 21% of deaths from CAD, 18% from CVA, 82% from COPD; 390,000 Americans died from smoking in 1985)
What is the range of output volume of an MDI?
30-100 mL (which contains 5ug to 5mg of drug)
What percent of maximum oxygen consumption should not be exceeded if a pulmonary rehabilitation patient is expected to maintain work output for an eight hour day?
30-40%
How much memory can a computer with an optical disc store?
300 to 900 MB
What are the surface tensions of pure water and physiologic saline respectively?
75 dynes/cm and 70 dynes/cm (alveolar lining fluid layer varies from near zero at low alveolar volumes to about 45 dynes/cm at large alveolar volumes)
In a normal 75 year-old who is breathing room air at sea level, what is the expected arterial PO2?
75 torr
How much additional flow is available to the patient when switching from the A/C mode to the CPAP mode on the Bear5?
20 L/min (A/C - 150 L/min, CPAP - 170 L/min)
What is the normal DLCO for women?
20 ml/min/mmHg
How long should a respiratory therapist wait before sampling and analyzing an arterial blood sample following a major change of ventilatory support in a critically ill patient?
20 to 30 minutes
Approximately how many micrograms of ipratroprium bromide are released by one actuation of a MDI?
20 ug (800 ug of chromolyn sodium, 90 ug of albuterol)
How much may the VC vary from predicted normal values in healthy individuals?
20%
S. aureus is present in the anterior nares of what percent of the general population?
20%
What is the mortality of bleomycin-induced lung disease?
20%
What is the 1 year mortality rate for patients with cardiac causes of syncope?
20% or greater
What is the limiting pressure of the Lanz pilot balloon?
20-25 mmHg
What is the driving pressure of most liquid O2 sources?
20-25 psi (max. flow - 8 L/m, 0-15 with stationary units)
What percent of patients with pneumococcal pneumonia have a positive blood culture?
20-25%
The first breath of the newborn generates a pleural pressure between -40cmH2O and -100cmH2O. What volume of air enters the lungs as a result of this pressure change?
20-30 ml
In sarcoidosis, what is the most common age range at the time of diagnosis?
20-30 years
The diaphragm develops during what gestational week?
7th week
Testing may be discontinued if a subject is unable to perform a single acceptable maneuver after how many attempts?
8
At birth, HbF represents 77-85% of the total Hb present. At what age is it totally converted to adult Hb?
8-11 mo
What is the average period of exposure to asbestos before developing symptoms of asbestosis?
20-30 years (rarely < 10 years of exposure)
What serum IgE level suggests allergies?
200 IU or higher
What type of ventilator was used at the University of Copenhagen during the epidemic of poliomyelitis in 1953?
200 medical students continuously hand ventilated 40-70 hospital patients
What is the length of the average suction catheter?
22 inches
Most HCH's are capable of delivering what range of humidity?
22-30 mg H2O/L
what volume will be occupied by one mole of dry gas at 0C and one atm of pressure?
22.4 liters
If you are performing a pre-post comparison study using ipratroprium as the bronchodilator, how long should you wait for maximum bronchodilation?
45 minutes (5 minutes for isoproterenol, 15 minutes for albuterol)
Hypercapnia is evidenced by what PaCO2 value?
45 torr (upper limit of normal)
In the study quoted in the CDC "guideline for prevention of nosocomial pneumonia," what percent of healthy adults aspirate during sleep?
45%
If volume deposition of bland solutions is the clinical objective, what particle sizes will deposit larger volumes at the bronchiolar level?
8-20 micrometers
When comparing smokers to non-smokers, how many times is the risk of bronchogenic carcinoma following asbestos exposure increased for smokers?
80 to 90 times
In general, airflow values less than what percent of predicted are considered abnormal?
80%
What is the maximum temperature obtained from the "doughnut style" heaters?
80-85 degrees F
According to P & K, the cabin pressure on commercial airliners is generally planned to be similar to a barometric of what altitude?
8000 feet (actual measurement shows a range of 5673-8915 ft. with a median of 6214 ft.)
Five degrees of the Celsius scale is equivalent to how many degrees on the Fahrenheit scale?
9 degrees
Fever will increase the heart rate by how much?
9-10 BPM for each 1F increase
What are the cannula lengths available on the Olympic Trach Button?
9-14 mm in 1mm steps (each diameter is available in two lengths - 27 & 40mm; five spacers are available in 1,2,4,7,10mm thicknesses)
Expressed in m/sec2, what is the force exerted on a mass due to gravity?
9.8 m/sec2 (reason that intrapleural pressure at the lung apex is about -9mH2O and at lung base only -3cmH2O)
In performing a single-breath DLCO test, how close to the patient's TLC is considered adequate for the test?
90%
In the premature infant, what percent of the sleep cycle is typically REM sleep?
90%
Wegener's granulomatosis is a systemic disease resulting in extensive damage to small blood vessels. What % of the time is lung also involved?
90%
When health services in the U.S. are divided into public, environmental, and personal types, what percent of money goes into the personal health services category?
90%
What does the BAL contain from healthy nonsmokers?
91-95% macrophages, 6-8% lymphocytes, 1% granulocytes (neutrophils & eosinophils)
Of the particles produced by the SPAG unit, what percent are smaller than 5micrometers and what is their MMD?
95%, 1micrometers MMD
What percent of the O2 that we normally consume is reduced by cytochrome oxidase in the mitochondria without any production of detectable free radicals?
98%
At a flow of 12 L/min, the back pressure should not exceed what value in a spirometer?
< 1.5 cmH2O
At what extremely low platelet count is the patient at risk for serious spontaneous internal hemorrhage (ie: brain hemorrhage)?
< 10-20 x 10 to the 9th/L
What is the formula for calculating Reynold's number?
NR = (v x d x 2r)/viscocity; where v = linear velocity, d = density, r = radius
What sleep disorder is diagnosed by the occurrence of at least two of four rapid eye movement periods within 15 min. of sleep onset during the daytime Multiple Sleep Latency Test (MSLT)?
Narcolepsy
Using the coronary arteries and Bernoulli's principle, explain what happens with "vascular flutter" during coronary artery disease.
Narrowing of a coronary artery produces an increase in velocity with a reduction in lateral wall pressure. The reduction in lateral wall pressure produces a collapse in the artery wall.
What is the relationship between NIOSH and OSHA?
National Institute for Occupational Safety & Health enforces the standards set by the Occupational Safety & Health Administration ("Cotton Dust Standard" - describes how spirometry is to be performed in the examination of persons exposed to cotton dust - basis for standards for spirometry)
Name 5 materials that are used for endotracheal tubes.
Natural rubber, synthetic rubber, polyvinyl chloride (PVC), silicone rubber (polysiloxane), Polyethylene
What four major factors influence solubility?
Nature of the solute, nature of the solvent, temperature, pressure
List 4 side effects of theophylline.
Nausea, vomiting, loss of appetite, abdominal pain, cardiac arrhythmias, seizures, cardiac and respiratory arrest
What are the two major control systems of the body?
Nervous system, endocrine system
What is the meaning of the term reticular, as in reticular density on CXR?
Netlike
An increase in neutrophils is called what?
Neutrophilia or a neutrophilic leukocytosis
What company manufactures a total body suit cuirass?
New Tech Associates
Cheyne-stokes respirations may occasionally be observed during sleep in normal individuals in what age groups?
Newborns, elderly
What are the four major atmospheric gases and the percent composition by volume of each?
Nitrogen - 78.08%, Oxygen - 20.95%, Argon - 0.93%, Carbon Dioxide - 0.03%'
A minimum exhalation time of 6 seconds is recommended unless what 2 conditions occur?
Obvious plateau of reasonable duration (no volume change for at least 1 sec.), and subject cannot or should not exhale further
What is the meaning of the term paroxysmal?
Occuring in sudden and usually violent attacks
In what unit is electrical resistance expressed?
Ohm
According to Hodgkin, there are four categories of the respiratory consequences of malnutrition. Name three of these four.
Respiratory muscle dysfunction, effect on control of ventilation, increased incidence of respiratory infections, changes in lung parynchymal structure
What is the most important mechanism by which a sympathetic impulse is terminated?
Re-uptake (not inactivation) of enzymes
The sweat glands of patients with CF have a diminished ability to do what?
Reabsorb Na+ and Cl-
By what trade name is salmeterol known in the United Kingdom?
Serevent (DPI at 50ug/blister - diskhaler, MDI at 25ug/puff - 2 puff BID)
What is the more common name of the drug which at one time was called hyoscine?
Scopolamine (only differs from atropine by an oxygen bridging the carbon-6 and carbon-7 positions)
When do elevated AST levels occur with MI?
Second day following MI
What principle is the primary mechanism for deposition of particles 1-5micrometers in diameter in the central airways?
Sedimentation
What are the two primary mechanisms for the deposition of particles of less than 4 microns in the lungs?
Sedimentation (settling by gravity), Brownian action
What do the Wintrobe and Westergren methods measure?
Sedimentation rate of RBCs
Name 5 factors that influence the penetration and deposition of aerosols in the respiratory tract.
Sedimentation, inertial impaction, diffusion, physical nature (hygroscopic vs. hypotonic), ventilatory pattern, pathologic obstruction of airways, size of particles
What level of bronchi are most commonly affected in bronchiectasis?
Segmental and sub-segmental
According to Dr. Howard Sprague, what is the greatest resource for help to the patient pursing rehabilitation?
Self-help
What is the most common cause of bacterial pneumonia and how are these organisms seen on gram stain?
Streptococcus pneumoniae; encapsulated, lancet-shaped, gram positive diplococci
What are the 3 principle components of physical rehabilitation for patients with clinical pulmonary disease?
Stress control, breathing control training, physical conditioning
When reporting a single-breath DLCO test, there are three corrections that are recommended but not required. Name 2 of them.
Subject's Hb, subjects COHb, altitude of the test
What term describes the change of state of matter from a solid state directly to a gaseous state?
Sublimation
Name a cytoprotective agent that has little effect on gastric pH, may have bactericidal properties of it's own, and has been suggested as a potential substitute for antacids and H-2 blockers.
Sucralfate
Laryngospasm is the primary concern in the first few minutes post-extubation as a result of sustained activation of the glottic closure reflex. This reflex is caused by the stimulation of what nerve?
Superior Laryngeal
If you were to inject 2-4 mL of 1% lidocaine into a patient's neck immediately external to the thyrohyoid ligament, what nerve will you be blocking?
Superior laryngeal nerve (sensory block of larynx for 2-5 min.)
what is the name of the enzyme which detoxifies the superoxide radical?
Superoxide dismutase
What is the now accepted use of the drug called alpha-1-antitrypsin?
Supplementation therapy for alpha-1-antitrypsin deficiency
What is the mean free path of molecules?
The average distance traveled by gas molecules between collisions
What is heat capacity?
The calories of heat required to raise the temperature of 1 gram of substance 1C or 1 pound of substance 1F
What is the heat of fusion? (or the latent heat of fusion)
The calories required to convert a quantity of a solid to a liquid at its melting point
What two key computer hardware components are combined in a CPU?
The central control unit and the arithmetic logic unit
What is there about the ipratroprium bromide molecule that prevents systemic absorption and thus prolongs action?
The charged nitrogen
What is the dominant part of the autonomic nervous system that controls airway caliber?
The cholinergic nervous system
Name four ingredients contained in a metered dose inhaler.
The drug, surfactant, chloroflourocarbons (F11, F12, F13, F14), flavoring agents, preservatives
What amount of pressure can be generated by manually stripping a chest tube?
Up to 400 mmHg inside the tube
How many apnea-hypopnea events per hour may adults experience without symptoms?
Up to 5
According to Egan, what percent of intubated patients aspirate pharyngeal contents around the cuff of an ETT?
Up to 70%
What size particles from an aerosol deposit respectively in the upper airways, the lower airways, and at the alveolar level?
Upper > 5micrometers, lower 2-5micrometers, alveoli 1-2micrometers
In phase one of a capnograph recording, what is the source of the exhaled gas?
Upper airway deadspace gas that contains little CO2 (phase two - mixed bronchial and alveolar gas, phase three - alveolar gas)
What are the 3 indications for bland aerosol administration?
Upper airway edema, bypassed airway, nee for sputum specimens
At what location in the lungs do bullae most often occur?
Upper lobes
With what chemicals are each of the six bonds available on a ferrous iron atom attached?
four are utilized in attaching each of the four pyrrole molecules, one binds the globin (specifically the imidazole group of the histidine residue), and one is available for the reversible attachment of oxygen.
What are two reasons why a particular gas may not be an "ideal" gas?
Real gas molecules have a finite volume, real gas molecules exert attractive forces (Van der Waal's forces) on one another
According to P & K, what are two relative contraindications to tracheostomy?
Recent sternotomy, presence of burned tissue or infection in the area of the tracheotomy
Hodgkin list four anti-inflammatory properties of steroids. Name any three.
Reduce microvascular permeability, reduce inflammatory response, reduce down-regulation of Beta2-receptors, reduce bronchial hyper-reactivity
Name any four of the goals of providing mechanical ventilation in a home care population.
Reduce mortality, decrease morbidity, improve quality of life, improve physical and physiological function, provide an environment that will enhance individual potential, be cost-effective
Financial loss from lost opportunity has a specific term that is used in decision making theory. What is this term?
Regret
One of the most potent chemokines that induce eosinophil and lymphocyte migration and attraction is called RANTES. What does RANTES stand for?
Regulated on Activation Normal T-cell Expressed and presumably Secreted
What is the primary advantage of delivering a drug by aerosol?
Relatively small quantities of drug may be given with maximal pulmonary effect and minimal extra-pulmonary effects
By what major mechanism is theophylline clearance from the blood achieved?
Removal by liver (a mixed function oxidase using Cytochrome P450) - 90% (the other 10% is removed by the kidney)
What are the two general reasons for intubation of the neonate?
Removal of material from the trachea, provision of a guaranteed airway
When delivering medications to mechanically ventilated patients through a small volume nebulizer, what should be done to the humidifier?
Remove from use
What are the three factors that influence the gas pressure within a container?
number of molecules, temperature, volume of the container
What level of serum phosphorus is termed severe hypophosphatemia?
< 1mg/L (caused by chronic alcoholism & alcohol withdrawal, dietary deficiency, recovery phase of diabetic ketoacidosis, respiratory alkalosis)
In pre-operative screening of pneumonectomy candidates, redirection of right ventricular blood flow to the good lung should result in a pressure increase to less than what value to be consistent with acceptable post-operative pressures?
< 35 mmHg
What recommendation does the EPA have for the amount of radon in the air inside a dwelling?
< 4 pCi/L (picocuries/liter)
How low must the platelet count fall before the clinician must be alert to the potential of increased bleeding?
< 50,000 platelets/mm3 (< 20,000 - even routine invasive procedures have risk of profound hemorrhage - sxn, ABG's)
What is critical temperature?
the temperature above which a substance cannot exist in a liquid state at any pressure
According to Ruppel, a mixed venous saturation below what percent is indicative of cardiovascular decompensation and tissue hypoxia?
< 60% (60-70% range - limited ability to deliver more O2 to tissues)
According to P & K, what peak flow value defines severe asthma?
< 80 L/min or < 25-30 of % predicted (mod-severe = 80-200 or 30-60%, mild-mod = >200 or > 60%)
Hypoxemia almost always results if carboxyhemoglobin is above what level?
> 15% of total Hb
For purposes of weaning, what is the recommended PaO2/FIO2 ratio?
> 200
What is a pyopneumothorax?
A collection of pus and air in the pleural space
What is specific gravity?
A comparison of a substance's density to a standard (water for liquids and solids, Oxygen or Hydrogen for gases)
What is Eisenmenger syndrome?
A condition in which pulmonary vascular resistance is equal to or greater than systemic vascular resistance
What do you call a substance through which electrons flow?
A conductor
Define anemia.
A decrease in RBC count, Hb, and Hct
Specifically, according to Rau, what is the name of the enzyme which converts angiotensin I to angiotensin II?
A dipeptidyl dipeptidase called kininase II
For spirometers that measure MVV, what device is necessary when performing a calibration?
A sine-wave rotary pump (accuracy within plus or minus 5% from 0-250 L/min when tested with a 2L sine wave)
What do all free radicals have in common?
A single unpaired electron in the outermost shell
Q: In a healthy adult, breathing spontaneously, what proportion of the work of breathing can be attributed to the elastic forces opposing ventilation?
A: about 2/3
Q: What is the role of the external intercostal muscles during inspiration?
A: increase both the lateral and anteroposterior diameters of the thorax
Q: What is the normal value of Reynold's number in terminal bronchioles?
A: one
Adult Hb consists of a heme portion and a protein or globin group. There are 4 chains of amino acids, Alpha & Beta. How many amino acids are in each?
Alpha - 141, Beta - 146
The heterotrimeric protein known as the "G-protein" is really composed of three subunits. What are the names of each of the subunits?
Alpha, beta, and gamma
Name 4 of the 7 potentially harmful pulmonary consequences of PPV.
Alteration in V/Q ratios, hyperventilation respiratory alkalosis, pulmonary barotrauma, ATX, airtrapping, increased WOB
In a forced expiratory volume tracing, how long should the forced expiratory effort last?
At least 6 seconds or until there is no volume change for at least 2 seconds
How long after upper abdominal surgery are lung volumes reduced?
At least 7 days
How often should spirometer quality control be performed?
At least each day the spirometer is used
During MVV testing, how many acceptable maneuvers should be obtained?
At least two and the results should not differ by more than 10%
For a slow vital capacity test, how many maneuvers should be measured?
At least two and they should agree to within 5%, or more maneuvers must be measured
Name any two of the non-depolarizing neuromuscular blockers that are considered intermediate-acting.
Atracurium, Cisatracurium, Vecuronium, Recuronium, Mivacurium
Medicated cigarettes were introduced to the western world in the early 1900's for the control and treatment of bronchospasm. What three drugs were used as medications?
Atropine, Stramonium, Belladonna
How do you determine tube placement with an esophageal detector device?
Attach to ETT and squeeze self inflating bulb. If it does not reinflate or does so slowly, it is in the esophagus
What are the three variables of the Expectancy Theory?
Attractiveness, performance-reward linkage, effort-performance linkage
What term describes the phenomenon whereby a portion of lung requires resection is seen to have no ventilation, perfusion, or preoperative ventilation perfusion scans?
Auto lobectomy
What do you call the receptors located on the presynaptic neuron of the parasympathetic nervous system?
Autoreceptors
Whose law states that equal volumes of all gases, at the same temperature and pressure, occupy the same volume?
Avagadro's law
During APRV, the clinician has control over what four parameters?
Baseline pressure, release pressure, release frequency, release time
What two ventilators allow dual control of breaths.
Bear 1000, Bird 8400sti
As a liquid, what color is O2 and how many times heavier is it than water?
Blue, 1.14 times heavier
What two parameters are used to estimate tidal volume with the Radford nomogram?
Body weight, breathing frequency
During a body plethysmography test, what three transducers are components of the body box?
Box pressure transducer, mouth pressure transducer, flow at mouth transducer
Whose gas law is described as "if absolute temperature and mass remain unchanged, volume varies inversely with pressure"?
Boyle's
Whose gas law states that for a given mass of gas, the volume and pressure are inversely proportional when the temperature is constant?
Boyle's law
Whose law explains the relationship between gas volume and absolute pressure at a constant temperature and mass of gas?
Boyle's law
What three gas laws are combined in the ideal gas law?
Boyle's, Charles', and Avogadro's laws
What do you call the force responsible for moving electrons through a conductor?
Electromotive force or potential (units - volts)
How is the ALT enzyme affected by myocardial infarction?
Elevated minimally or not at all unless secondary to severe liver congestion
What is defined by the description "growth designed to increase the status of the administrator without benefiting the organization"?
Empire building
Name 3 methods used to quantify auto-PEEP.
End expiratory hold, use of Braschi valve, respiratory inductive plethysmography, Servo 940 mechanics calculator, esophageal pressure monitor
Corticosteroids are a complex group of drugs that do not act within the nervous system. What system do they act within?
Endocrine
Maternal blood enters the placenta through which arteries?
Endometrial
State the first law of thermodynamics.
Energy can neither be created nor destroyed
Define the term energy.
Energy is the ability to do work
What is a neutral thermal environment?
Environmental temp at which the baby must expend the least energy to maintain its proper temperature
Name two drugs that increase neutrophils.
Epinephrine or steroids
What does EGTA stand for?
Esophageal gastric tube airway
How many sleep centers, sleep laboratories, and other sleep testing facilities are there in the United States?
Estimates range up to 3,000
What are the 2 functions of BAL?
Evaluate the need for therapy in patients with ILD by analysis of the cells obtained in the lavage solution; To serve as a diagnostic tool in diseases such as PCP & asbestosis
How often is amniotic fluid replaced by exchange between the placenta, tracheobronchial tree, umbilical cord, fetal skin, and fetal urine?
Every 3 hours
How often is the United States Pharmacopeia revised?
Every 5 years
The abbreviations XOD and NOD refer to subsets of patients of the general COPD population. What doe the abbreviations XOD and NOD stand for?
Exercise Oxygen Desaturation and Nocturnal Oxygen Desaturation
What term applies to the act of coughing up and spitting out material raised from the respiratory tract?
Expectoration
USNs operate at a frequency of 1.3-1.4 MHz. What government agency sets this frequency?
FCC
What is another name for the maximum expiratory flow rate?
FEF200-1200 (refers to the flow rate for the liter of forced expired air after the first 200 mL)
What is another name for the maximum mid-expiratory flow?
FEF25-75%
According to P & K, why should age-specific predicted values for FEV1/FVC ratio be used instead of an absolute limit of this ratio?
FEV1 declines with age at a faster rate than does FVC (30 mL vs. 20 mL/year)
What changes are considered a positive bronchodilator response?
FEV1 increases by at least 200mL or 12-15% of pre-dilator study
Early termination of a FVC maneuver may overestimate what two volumes?
FEV1/FVC and FEF25-75
What is normal FIO2 and PO2 in dry atmospheric gas at sea level?
FIO2 = 0.2095, PO2 159 mmHg (0.2095 x 760)
What is normal FIO2 and PO2 in dry atmospheric gas at an altitude of 25,000 feet?
FIO2 = 0.2095, PO2 = 59 mmHg (0.2095 x 282)
A fluid with low protein content that has passed from capillaries through a serous membrane as a result of hydrostatic and colloid osmotic pressure changes
G & H notebook
Whose gas law explains why a regulator attached to a cylinder in use will feel colder than the environmental temperature?
Gay-Lussac's law
Whose gas law states that if the mass remains constant, the pressure varies directly with the absolute temperature when the volume remains constant?
Gay-Lussac's law
For what two types of patients is aerosol administration of drugs by face mask indicated?
Infant/pediatrics and unresponsive patients
Neutrophilia is typically one of the body's first responses to what?
Infection and inflammation, bacterial pneumonia
Farzan divides the environmental pulmonary pathologic agent into what 4 categories?
Infectious agents, organic dusts, inorganic dusts, gases
What two kinds of analyzers may be used to continuously monitor expired CO2?
Infrared or mass spectrophotometer
according to Branson, what are the 4 reasons for the low tidal volumes delivered by the single-operator bag-valve mask technique?
Leaks around the mask, difficulty maintaining an open airway with one hand, difficulty to squeeze 800-1200 cc out of the bag with one hand, difficulty to coordinate the delivery of breath during chest compressions so that gas is delivered into the lungs rather than the stomach
In the assessment of dysfunction related to pulmonary disease, what do the initials LDB stand for?
Leisure Diagnostic Battery (LEEP = Leisure Education and Enrichment Program)
What are the 3 primary advantages of He rebreathing methodology over other gas dilution techniques?
Requires minimum patient cooperation, low cost of components, the analyzer need only be linear
By what percent will the resistance change when going from a 6.0 mm ID ETT to a 5.0 mm ID ETT?
Resistance will double (if radius decreases by 16%, resistance doubles)
Apnea-hypopnea index - average number of hypopnea-apnea events/hr of sleep
Resp. Care, Dec. 1995, p.1288
When used as an indicator for predicting successful weaning from mechanical ventilation, what value of f/VT is predictive of successful weaning?
Less than 105
How long does it take an individual who is proficient in intubation to complete and intubation of a patient?
Less than 30 seconds
In healthy subjects, the anaerobic threshold occurs at about 60-70% of VO2 max. What anaerobic threshold is considered abnormally low?
Less than 40% of VO2 max
To avoid atelectasis during suctioning, the external diameter of catheter should never exceed what internal diameter of the airway?
½
What proportion of commercial spirometers do not meet the ATS spirometry standards?
½
When weaning long term patients with PSV, P & K recommend setting the initial pressure value at what level?
½ the PIP then adjust for RR = 12-24
What is the risk of respiratory distress syndrome if the L/S ratio is 2:1 or greater?
Less than 5% (at 1:1, probability is 90%, at 1.5:1, probability is 50%)
On a forced expiratory volume tracing, how small should the back-extrapolated volume be for the tracing to be acceptable?
Less than 5% of the FVC or 100 mL, whichever is larger
If the severe COPD patient in acute respiratory distress is too short of breath to perform a FVC maneuver, what is the probable value of FEV1?
Less than 500 ml
How long does it take for the nicotine absorbed by smoking to travel to the brain?
Less than 8 seconds
What proportion of physicians commonly advise their patients to give up smoking?
Less than half
What are the recommended safe doses of Lidocaine, Cocaine, and Benzocaine?
Lido - 4.7mg/kg, Cocaine - 2.3mg/kg, Benzo - 10mg/kg
According to P & K, what is the only small home care ventilator that incorporates a blender?
Life care PLV-102
What term refers to the accuracy of an instrument over its entire range of measurement or its capacity?
Linearity
What do the initials MSVC mean?
Maximum Sustainable Ventilatory Capacity (estimated MSVC = 14.8 x peak insp. flowrate; getting an actual MSVC is time-consuming and uncomfortable for the patient)
What does the FEF25% (Vmax25) measure?
Maximum flow after 25% of the FVC has been exhaled (FIF50% = max inspiratory flow after 50% of the FVC has been inspired)
Some endotracheal tubes do not have a Murphy eye. What are these tubes called?
McGill tubes
The impact of positive pressure ventilation on the circulatory system depends on what two factors?
Mean pleural pressure (or mean airway pressure), and patient's cardiovascular status
In a COPD patient with increasing CO2 retention, what drug could be given as a respiratory stimulant?
Medroxyprogesterone (Provera; about 10% of men experience loss of libido & potency)
When do the highest LDH elevations occur?
Megoblastic anemia, widespread carcinoma, sever shock
What term denotes the temperature at which a solid converts to a liquid?
Melting point (or freezing point)
Acetyl-beta-methylcholine is also known by what other three names?
Metacholine, Mecholyl, Provocholine
According to Farzan, what is the most common cause of massive pleural effusions?
Metastatic cancer of the pleura
Name any two direct acting parasympathomimetic drugs. (structurally similar)
Methacholine (bronchial challenge), Carbachol, Bethanechol (both used to relieve post-op urinary retention), Pilocarpine (causes miosis in ophthalmology)
What is the dose-limiting side effect of Beta2-specific agents?
Muscle tremor (tachycardia is dose-limiting side effect of older adrenergics with strong Beta1 and alpha effects)
List other diseases that LDH elevations are also seen in.
Muscular disease, leukemia, hemolytic anemia, infectious mononucleosis, liver disease, renal disease, & hypothyroidism
What do you call the type of lymphocyte that has spontaneous cytolytic activity against tumor cells?
"Natural killer" cells
One torr is equal to how many kilopascals?
0.133 kPa
What is the density of oxygen?
1.429 g/L
What is the standard density of carbon dioxide?
1.965 gm/L (O2 = 1.43 gm/L, N2 = 1.25 gm/L)
Aspiration of gastrointestinal material occurs in approximately what percent of mechanically ventilated patients?
30-40%
Sleep apnea syndrome refers to a pathologic condition in which the number of apneic episodes exceed how many per hour?
5 (8 in the elderly)
What percent of the body's sodium is extracellular?
95%
According to P & K, what percent of HIV infections world wide have occurred from heterosexual transmission?
> 60%
What Na+ and Cl- concentrations are present in CF sweat?
> 60-80 mEq/L
Q: Of what two substances is heme composed?
A: Porphyrin and iron atoms
During fetal life, the lung receives what portion of total cardiac output?
About 10% (15% in one source)
What term describes how well an instrument measures a known reference value?
Accuracy
What is absolute humidity?
Actual mass (weight) of water per volume of air
According to P & K, surfactant is present in lung fluid at what gestational age?
After 24 weeks gestation
What term is used to describe a drug that has affinity and produces an effect?
Agonist
What do you call a drug that has affinity but lacks efficacy?
Antagonist
The National Cancer Institute advises physicians to use a four-step process to aid smokers in quitting. What are the key components?
Ask, advise, assist, arrange
Name any five computer programming languages.
BASIC, FORTRAN, COBOL, PASCAL, LISP, FORTH, and C
What other name is the hydrodynamic nebulizer known by?
Babbington
What term is used to describe a non-homogeneous, patchy, non-lobar opacity seen on CXR?
Bronchopneumonic
A patient's ventilatory capacity is determined by what two key components?
CNS drive, muscle performance
By weight, what is the predominant pollutant in the US?
Carbon Monoxide
What material comprises the anode of the Clark electrode?
Chloridated silver
In penicillin-allergic patients with an anaerobic pneumonia, what is the preferred antibiotic?
Clindomycin
What is the most commonly used method for measuring residual volume?
Closed circuit helium equilibration (dilution)
What specific organism is almost always the cause of infection-related diarrhea?
Clostridium difficle
What are a group of chemicals secreted by the adrenal cortex and are referred to as adrenal cortical hormones?
Corticosteroids
What is the meaning of the term dysphagia?
Difficulty swallowing
What type of inhaler is a "breath-actuated meter-closing" system?
Dry powder inhalers
What is the cause of macrocytic or megaloblastic anemia?
Folate of vitamin B12 deficiency
In the newborn heart, what structure closes when left atrial pressure is greater than right atrial pressure?
Foramen ovale
What is pressure?
Force per unit area
What is pectus excavatum?
Funnel chest
Name any 5 types of antihypertensive drugs that may act as sexual depressants.
Ganglionic blockers, -adrenergic blockers (in high doses), -adrenergic blockers, false sympathetic transmitters, Clondine, Reserpine, diuretics
What drug is the most popular expectorant?
Guaifenesin (formerly known as glyceryl guaiacolate, guaicol is a catechol)
The character of sputum may be highly indicative of the underlying disorder. Rusty colored sputum may be presumptive for pneumococcal pneumonia. What possible cause might give sputum a thick, apple green appearance?
H. influenza pneumonia (pink, thin, blood-streaked strep or staph pneumonia; red currant jellyklebsiella)
What bacterial organism is the most common cause of epiglottitis?
Haemophilus influenza (type B)
To what extent will a Beta2-agonist, delivered by MDI result in relief of bronchospasm in a stable asthmatic within the first 30 seconds?
Half (peaks at 60 min> continues 120 min and back to baseline at 4-5 hours)
Which ventilator provides pure pressure-targeted MMV?
Hamilton Veolar (varies level of PS to ensure MMV level, on the Bear5 - SIMV & PSV are combined for MMV)
What are the three parts of the stylet fiberoptic laryngoscope?
Handle, body, stylet
What two main areas in PFT and blood gas labs do OSHA regulations govern?
Hazard communication & training, training regarding blood-borne pathogens
According to P & K, one of the earliest descriptions of the Pickwickian syndrome involved a patient with what interesting complaint?
He fell asleep during a poker game and failed to bid on a "full house"
What is the simplest pleural drainage system?
Heimlich valve
State two reasons cricoid pressure is useful during ET intubation.
Helps prevent regurgitation, moves the anterior larynx into better position for visualization
The passage of black, tarry stool or the presence of black vomitus is referred to a melena. What is the proper term that describes the presence of fresh blood in the stool?
Hematochesia
Hepatitis B and the dysequilibrium syndrome are two common untoward effects of what procedure?
Hemodialysis
What tube produced by National Catheter Corp. provides an orifice for jet ventilation and one for pressure monitoring?
Hi-low Jet tube
What is singultus?
Hiccups
HEPA filters can provide a way to reduce particulate matter from inside a dwelling. What does HEPA stand for?
High Efficiency Particulate Air
What is the presumed reason for the predilection of adult TB for the apex of the lung?
Higher PO2 due to normal variations of ventilation-perfusion from the apices to the bases
Name any three receptors whose activation causes constriction of airway smooth muscle.
Histamine(H1), Muscarinic(M1), Alpha1-adrenergic, Adenosine(A1), SP-P, Leucotrienes (C4,D4,E4), Prostaglandin(D2, F2Alpha), PAF, Thromboxane A2, Bradykinin
Name any 4 of the mediators which are released from activated mast cells.
Histamine, Eosinophil chemotactic factor of anaphylaxis (ECFA), neutrophil chemotactic factor (NCF), leukotrienes (formerly SRS-A), prostaglandins, platelet activating factor (PAF)
According to Branson, what is the only company to presently manufacture a HCHF?
Humid-Vent Filter from Gibeck-Dryden
What type of immune response involves the activation of specific B-lymphocytes to produce antibodies directed at antigens on the surface of the particle?
Humoral (eg: response to vaccines)
What do you call the branch of physics involved in the study of fluids in motion?
Hydrodynamics
What type of chemical attractive forces cause adenine to pair with thymine in DNA?
Hydrogen bonds
Name two instruments that can be used to measure relative humidity.
Hygrometer, psychrometer
Q: Patients with increased PTH have what?
Hypercalcemia
What term refers to a low blood sodium level?
Hyponatremia
Name 4 hazards associated with the use of HME's.
Hypothermia, underhydration, impaction of pulmonary secretions, potential increased WOB, hypoventilation secondary to increased deadspace, inaccurate low pressure alarm with ventilator disconnection due to the high resistance when ventilating through the HME.
What do the acronyms HVR and HCVR stand for?
Hypoxic ventilatory response, hypercapnia ventilatory response
The pressure-volume curves during inspiration and expiration are different. By what name is this behavior of the lungs known?
Hysteresis
According to P & K, what type of weaning method is most commonly used in the U.S. at present?
IMV
What term means "caused by the physician"?
Iatrogenic
Cryptogonic fibrosing alveolitis is more commonly know by what term?
Idiopathic pulmonary fibrosis
Type II (cytoxic hypersensitivity) immunologic reactions are mediated by which antibodies?
IgG or IgM
Topical agents that anesthetize the supraglottic structures have what other effect on the patient?
Impair protective reflexes
What is the strict meaning of the word atelectasis?
Imperfect expansion
What happens to DLCO in patients with Goodpasture's syndrome and why does it happen?
Increases (spuriously) due to uptake of CO by RBC's in the alveolar spaces
What effect does the administration of NaHCO3 have on intracellular and cerebrospinal PCO2?
Increases PCO2 as it is produced by hydrolysis
Name any two mechanisms by which pentamidine may produce its effect on P. carinii.
Inhibition of RNA synthesis, inhibition of DNA synthesis, inhibition of oxidative phosphorylation, interference with folate transformation
According to Egan, what are the three main diagnostic uses of fiberoptic bronchoscopy?
Inspection of lower airways, bronchography (injection of dye to visualize airways radiographically), acquisition of specimens for pathological examination
What term refers to the small silicon-based semiconductor chip upon which thousands of miniaturized transistors are placed in a computer?
Integrated circuit
What is the FIO2 and humidity range of the Oxygen Enrichment Company OE Plus membrane humidification device?
It produces 6 L/min of 30-40% O2 with 30-38 mg/L of water vapor
What are colloids?
Large molecules or clumps of molecules able to attract and hold large numbers of water molecules (also called dispersion or gels)
What is the term for the space within a tube?
Lumen
Who manufactures the Endotrol ETT and the Hi-lo Jet tube?
Mallinckrodt Critical Care
A decrease in neutrophils is called what?
Neutropenia
What do you call the preparation and dispensing of drugs?
Pharmacy
What is the modern definition of a base?
Proton acceptor (Bronsted Lowry)
What are the 3 components of an atomizer?
Reservoir, capillary tube, jet
What calculated value is the Weir Equation used to determine?
Resting energy expenditure (REE = VO2(3.941) + VCO2(1.11)), 1440 min/day
What are the two available types of lighted stylets?
Rigid, flexible
What drug may be given instead of H2 blockers and antacids and has the advantage of reducing bacterial counts in the stomach?
Sucralfate (carafate)
What is cheilosis?
Superficial crusted fissures in the corners of the mouth
What enzyme is a scavenger of superoxide?
Superoxide dismutase
What is the most common dispersal agent used in MDI's?
Surfactant (commonly soyalecithin, sorbitan trioleate, and oleic acid; dispersal agents used to improve drug delivery by keeping the drug in suspension)
What is the most common dispersal agent used in MDI's?
Surfactant (used to improve drug delivery and to keep the drug in suspension; others include sorbitan trioleate - Span 85, lecithin, oleic acid)
What is the term used to measure the pressure of a gas or liquid?
Tension
What is the usual relationship between an MVV test result and an FEV1 test result?
The MVV should equal the FEV1 x 35
What is a BTU?
The amount of heat required to raise 1 pound of water 1 degree F
What do you call the response that the body makes to an antigen?
The immune response
With regard to a pulmonary rehabilitation program for a patient, what should be the "cornerstone"?
The initial assessment
On an FEV test, what is meant by "best" test result?
The maneuver with the largest sum of FVC and FEV1
What are the two limiting factors in the use of dry powder inhalers available in the U.S.?
The need for high inspiratory flowrates (<50 L/m there is a significant reduction in clinical response), lack of availability of drugs in this form
Amylase in the blood and urine is predominantly from where?
The pancreas and salivary glands
What is reported mortality rate of tracheotomy?
Up to 5%
What is work?
Work = force x distance
What are the primary units in the metric system for length, volume, and mass respectively?
length = meter, volume = liter, mass = gram
If you put carbon dioxide gas through a blender calibrated for oxygen, what would the flow rate be as compared to that of oxygen through the same blender?
only about 85% (actual flow of gas = Square Root of(density of gas B/density of gas A))
The pK of oxyhemoglobin is 6.2. What happens to the pK when oxyhemoglobin becomes deoxygenated?
pK shifts to 7.7 (the imidazole ring of histadine is responsible for most of hemoglobin's buffering activity - its pK = 7.0)
What term is used to describe the four pyrrole groups linked by methylene bridges as they are in hemoglobin?
porphyrin (a metaloporphyrin with iron in hemoglobin)
How many ventilator dependent patients are there in the U.S. today?
10,000
What is the water vapor content produced by a bubble humidifier?
10-20 mg/L
What is the therapeutic range of theophylline?
10-20 ug/mL
According to the AARC CPGs, what is the recommended criterion for response to a bronchodilator in adults for FEV1 and FVC?
12% improvement from baseline and an absolute change of 200 mL
Because of the potential for development of granulation tissue and for obstruction by secretions, fenestrated trach tubes should not be plugged for longer than what duration?
16 hours
In individuals with asbestos exposure and counting from initial exposure, how long before the risk of developing mesothelioma reaches its peak?
30-35 years
Low volume, high pressure cuffs have been shown to exert what range of pressures?
40 to >200mmHg
In term of respiratory muscle endurance, what percent of their MVV can normal individuals sustain over extended periods of time?
40%
Expressed as a percent of TLC, what is the resting volume of the lung at FRC?
40% (expressed as a percent of vital capacity, what is the resting volume of the chest wall - 70%)
The O2 enricher concentrator provides what FIO2 and humidity concentration?
40% at 3 times the ambient relative humidity
When considering the oral intubation of a patient with TMJ or masseter spasm (trismos), how far should the jaw open if there is no interference with jaw opening?
40-45 mm (first 20 mm by action of hinge, another 25 mm or so from forward displacement)
What is the dominant frequency of a wheeze?
400 Hz or more
Expressed in parts per million, what is the range of concentration of nitric oxide in cigarette smoke?
400-1000 ppm
According to a study by Openbrier, what percent of emphasematous patients showed evidence of malnutrition?
43%
What is the half-life of carboxyhemoglobin when air breathing?
5 hours (100% oxygen > 1 hr)
What are the minimal volume sensitivities and time base of recorders used for diagnostic purposes?
5 mm/L and 1 cm/sec (manual measurements 10 mm/L & 2 cm/sec, on flow-volume loops a ratio of 2:1 between flow:volume should be maintained)
When performing a two-point manual calibration of the pH electrode of a blood gas analyzer, what are the pH's of the "low" and the "high" buffers?
6.84 and 7.38
What are 6 of the equivalent expressions of 1 atm of pressure?
760 mmHg, 76 cmH2O, 29.9 inches Hg, 33.9 feet H2O, 1034 g/cm2, 14.7 psi, 1.014 x 106 dynes/cm2, 1014 millibars, 101.32 kilopascals
Post natal growth of the lung continues until what approximate age?
8 years
What % of all term infants have some degree of meconium staining in the amniotic fluid at birth?
8-10%
According to the AHA, what is the recommended volume that should be delivered to a patient during mask ventilation?
800ml (range 800-1200; ASTM - 600ml)
What percent of difficult intubations may be anticipated by performing a thorough evaluation of the airway in advance?
98%
According to McPherson, what is the minimum peak flow setting that can be used when the nebulizer function is activated on the PB7200?
> 15 L/min (Burton says 20 L/min, p.545)
What do you call a simple valveless extension device that puts distance between an MDI and the patient's mouth?
A "spacer"
Chemically, what structural features do all catecholamines have in common?
A benzene ring with hydroxyl groups at the 3rd and 4th carbon sites and an amine side chain attached at the 1st carbon position
What is the difference between a bullus and a bleb?
A bullus is a radiolucent area surrounded by more or less normal lung; a bleb is a superficial bullus abutting the pleura
Name any two substances which may be responsible for causing neutrophil accumulation in the lungs of ARDS patients.
A chemotactic factor, arachidonic acid metabolites, leukotriene B4
What is defined by the description, "diameter of a sphere of unit density that settles at the same point, when projected horizontally, as the particle being tested"?
Aerodynamic Mass Median Diameter
What is meant by the terms hyperbarism and hypobarism?
Air pressure significantly above or below normal sea level air pressure (760mmHg)
What disease has been called "chronic desquamating eosinophilic bronchitis"?
Asthma
Most bacterial nosocomial pneumonias occur by what mechanism?
Aspiration of bacteria colonizing the oropharynx or upper GI tract
For a slow vital capacity maneuver, at what points should the measurement be taken?
At RV and at TLC
Whose gas law states that at equal temperatures and pressures, equal volumes of different gases will contain equal number of molecules?
Avogadro's law
By what mechanism do unmyelinated sensory nerve ending of the c-fiber type release "tachykinins" such as substance P?
Axonal reflex
The Ck present in the myocardium has one component similar to that found in the brain and one similar to that found in muscle known as what?
Ck-MB
The PTL airway has two PVC tubes of unequal length. What is the length and diameter of each tube?
Clear tube - 31 cm long, 8 mm diameter, green tube - 21 cm long, 8 mm diameter
Whose law states that the total pressure of a mixture of gases is equal to the sum of partial pressures of each constituent gas?
Dalton's law of partial pressures
What is the common name that refers to the painless enlargement of the terminal phalanges of the fingers and toes which is a manifestation of cardiopulmonary disease?
Clubbing
At what temperature does liquid O2 turn back to the gaseous state regardless of the pressure exerted?
-188.6 degrees Celcius (critical temp)
According to Egan, what is the recommended suction pressure for infants?
-60 to -80 mmHg (adults -100 to -120 mmHg, peds -80 to -100mmHg)
What is the solubility coefficient of oxygen in plasma?
0.023 ml/ml plasma at 37C and 760 mmHg
Oxygen composes about what percentage of all atoms in the universe?
0.09%
The most commonly used skin test for TB requires what material and how much?
0.1 mL of PPD (purified protein derivative)
If an oxygen analyzer is going to be used in exercise tests in patients breathing room air, over what range should they be calibrated?
0.12 to 0.21
In normal individuals without obstructive sleep apnea, how long before diaphragmatic activity does upper airway muscle activity start?
0.2 seconds
Lucien Dautre-bande became the world authority on micro-aerosols starting in 1941. What mixture of drugs did he promote as the "best" bronchodilator solution?
0.25% isoproterenol, 0.5% cyclopentamine, 0.1% atropine
When accessing the ability to wean a patient from mechanical ventilation, according to P & K, oxygenation is deemed adequate when the PaO2 is above 60 mmHg with an FIO2 of what value?
0.35
Most incubators are equipped with air inlets that prevent FIO2 from exceeding what value unless the inlets are closed?
0.40
What is the ionization constant of water?
1 x 10-14
Therapeutic agents which vasodilate pulmonary vasculature fall into what four categories?
1) Act directly on smooth muscle (nitroprusside) 2) Act on adrenergic receptors (isoproterenol) 3) Act on calcium channels (nifedipine) 4) Act as inhibitors or ACE (captopril)
Name any three adverse actions of theophylline in humans.
1) CNS stimulation including seizures 2) Relaxation of lower esophageal sphincter 3) Increased gastric volume, acidity 4) Vasodilation, increased pulse rate 5) Increased myocardial irritability 6) Nausea, vomiting 7) Headache, cerebral vasoconstriction 8) Decreased red cell mass 9) Increased catecholamines, cAMP
What are the symptoms of laryngeal stenosis?
Stridor and hoarseness
What assumption is made when using only a two-patient calibration of gas analyzers?
That the analyzer output is linear between the points used for calibration
Normally, when does the ductus arteriosus close functionally and anatomically?
Functionally on 1st day, anatomically in 1st month
How is density of a gas calculated?
GMW/22.4L
Meteorism is another word for what complication of bag-mask manual ventilation?
Gastric distention
Whose gas law is described as "if the volume and mass remains fixed, the pressure exerted by a gas varies directly with the absolute temperature of the gas"?
Gay-Lussac's
What do you get when phospholipase A2 hydrolyses phosphatidylcholine which then undergoes subsequent acetylation?
Platelet activating factor (PAF); 1-0-hexadecyl - 2-acetyl - SN-glycero - 3-phosphocholine = major metabolically active for of PAF
Name three situations in which auto-PEEP may develop.
Inadequate expiratory time without dynamic airflow obstruction (applied and auto-PEEP are additive), Generalized dynamic airflow obstruction, localized dynamic airflow obstruction
Between 1979 and 1985 the prevalence of COPD in men in the U.S. remained stable. What happened to women during this time period?
Increased by 35%
Exercise training causes what two major changes in the microscopic anatomy of skeletal muscles?
Increases the number of capillaries in the muscle, and increases the number of mitochondria in the skeletal muscle cells
Why are the drugs racemic epinephrine, isoethrane, and isoproterenol stored in amber bottles?
Light (in addition to heat air and metals) causes the conversion to adrenochrome. (Ephedrine-because it is not a catecholamine, can be taken orally)
In a computer, what are the two types of primary memory?
ROM or Read Only Memory, RAM or Random Access Memory (RAM is referred to as "volatile" memory - loss of electrical power cause all data stored to be lost)
What are van der Waals forces?
Relatively weak attractive forces between neutral molecules.
What physical/chemical property of noxious gases such as ammonia or phosgene determine the extent of irritation to eyes or upper airway mucosa?
Solubility
Name any three organs, other than the lungs, which are likely to be involved in patients with sarcoidosis/
Lymph nodes, liver, spleen, skin, and eyes
What decreased WBC is an important feature of HIV?
Lymphocytopenia
Name any two species of atypical mycobacteria.
M. aansasii, M. avium-intracellulare, M. Scrofulaceum
What was the first approach to ventilatory support that incorporated computer control of ventilation?
MMV
According to Rose and Cohen, what three factors predict an increase in difficult intubations?
Male, obesity, age 40-59 years
Based on evaluation of inspiratory muscle strength, what patients should receive inspiratory muscle training?
Males with < 70% of predicted, females with < 60% of predicted
What are the 4 major elements to consider in regard to a quality assurance program according to Ruppel?
Methodology, instrument maintenance, control methods, testing a sampling technique
What organization said "blood gas & pH analysis has more immediacy & potential impact on patient care than any other laboratory determination"?
National Committee for Laboratory Standards
What material comprises the thin wire cathode inside the Clark electrode?
Platinum
There is an increase in Maximum Breathing Capacity as an individual ascends in altitude. What single factor is primarily responsible for rise in MBC?
Decrease in density of air
Congenital anomalies of the great vessels fall into what 5 categories?
Double aortic arch, right aortic arch, anomalous innominate artery, anomalous left common carotid artery, aberrant subclavian artery
What term is defined by the following words? "Any chemical that alters the organism functions or processes"
Drug
The active ingredient in "ma huang" was first isolated in 1885. What name was the newly identified substance then given?
Ephedrine (Chinese used it for about 5,000 years, introduced into the US in 1926 and used in asthma in 1927)
What is the active ingredient in the drug called "Primatine Mist"?
Epinephrine
What is the only bronchodilator chemical available in an OTC preparation?
Epinephrine (in Primatine Mist)
Name any two of the primary determinates of residual volume?
Expiratory muscle strength, airway patency, chest wall mechanics
Alkaline phospatase is a liver enzyme elevated in many liver diseases. When do the highest values occur?
Extrahepatic obstruction of the bile duct
We know that a beta-agonist drug attaches to beta-receptors within a membrane. With which of the seven loops of the receptor does the drug form bands with?
loops #3,5,and 6
According to McPherson, what are the 6 general types of humidifying devices?
low by, bubble, jet, under water jet, heated, condensing
In general, a greater risk for sleep apnea exists for neck circumferences of greater than what value in women and men?
men > 17 inches, women > 16 inches
What are three basic forms in which RNA occurs?
messenger RNA, transfer RNA, ribosomal RNA
What is vol%?
ml of gas per 100 ml of liquid
How are pressures expressed in mmHg converted to cmH2O?
mmHg x 1.36
What is a calorie?
The amount of heat required to raise the temperature of 1 gram of water 1 degree celsius
What is volume?
The number of electrons able to participate in chemical reactions (atomic combining capacity)
What property is common to silicon, teflon, or similar substances used in the membrane to separate blood from the sensing electrode in a PCO2 electrode?
permeability to CO2
According to Branson, a low pressure or disconnect alarm should be set at what value?
plus or minus 10% or plus or minus 5 cmH2O, whichever is greater, of the desired pressure
With regard to ventilators, what is meant by the term "dual-control"?
The simultaneous capability of monitoring and using variables as control signals
Define mass median diameter.
The size of particles above and below which 50% of aerosol mass are distributed
What is an atom?
The smallest particle of an element that can take part in a chemical change
In a solution, what term describes the substance being dissolved, or going into solution?
The solute
How is REE defined?
The value obtained with the patient lying in bed, awake and aware of his/her surroundings
What is molar volume?
The volume occupied by one mole of a gas under standard conditions (molar volume for an ideal gas is 22.414 L)
What are the two compounds with which isoethrane was originally marketed?
Thenyldiamine (an antihistamine), phenylephrine (an alpha antagonist)
What do you call the art of treating disease with drugs?
Therapeutics
What is defined as "an activity or treatment designed to alleviate an undesirable condition"?
Therapy
What general type of surgical procedures have the greatest risk of post-operative pulmonary complications?
Thoracic procedures
What are the three available mode settings on the Respironics BiPAP unit?
Timed (control), timed/spontaneous (A/C), spontaneous (assist)
According to Chatburn's ventilator classification system, what are the four phase variables?
Trigger (time, pressure, flow, volume, manual), limit (variable that is reached and held during inspiration), cycle (ends inspiration when preset value is reached), baseline (controlled during the expiratory time)
Antidotes and poison control fall under what branch of pharmacology?
Toxicology
Subcutaneous emphysema is most dangerous to a child in what way?
Tracheal compression
A scratchy feeling behind the sternum is a common symptom in what disease?
Tracheobronchitis
What is the incidence of hypertension as compared to normal in patients with obstructive sleep apnea hypopnea?
Twice that of normal (2-4x ischemic heart disease, 4x cerebrovascular disease)
The infant oxygen hood is appropriate for infants not larger than what weight?
Up to 18 pounds
What is a normal bleeding time?
Up to 6 minutes
If the diaphragm is weak or paralyzed, which way does it move on inspiration?
Upward (paradoxical movement)
On the PB 7200a, the microprocessor control of the proportional solenoids are responsible for what ventilator functions?
Volume, flow, O2 percentage, wave form control
What is the relationship between the solubility coefficient of a gas and temperature?
it is an inverse relationship
What are three reasons why the nitric oxide free radical is an ideal local transcellular messenger molecule?
it is small, it's lipophilic, and it has a short duration of action (nitric oxide free radical once known as EDRF)
In terms of permanent disability in the U.S., what rank do respiratory diseases hold?
5th leading cause (about 123,000 workers received benefits from SSA in 1987 through the Old Age Survivors and Disability Insurance Program (OASDI), represents 4.8% of all disabled workers in 55-64 year olds)
According to the Social Security Administration's guidelines for disability due to asthma, how many hospitalizations or ER therapy per year are necessary before disability is present?
6 (in addition, patient must demonstrate wheezing between acute episodes)
Among patients with COPD receiving ventilatory support, those who fail to wean tend to have P0.1 values greater than what value?
6 cmH2O
Poor medical outcome is associated with a weight which is less than what percent of normal?
85% (MetLife insurance co.)
Of all the patients who receive CPAP therapy for the treatment of OSA, what percent utilize nasal CPAP?
85% (about 10% use BiPAP)
Fetal Hb accounts for what percent of the hemoglobin in the full term infant?
85% (contains two gamma chains instead of the normal two beta chains, increased affinity shift to the left)
At room temperature, by how many times does liquid oxygen increase it's volume as it converts from a liquid to a gaseous state?
862
Oxygen comprises what percent of the weight of water?
89%
When using the formula (reference - measured)/CI, what values would a severe obstruction patient show?
> 4 C.I. (< 1 - normal; > 1 & < 2 - mild; > 2 & < 4 - moderate; > 4 severe)
What is the current minimum criterion for obstructive sleep apnea-hypopnea?
> 5 AHI (apnea-hypopnea episodes/hour)
Q: Name the two muscles that form the diaphragm.
A: Costal, crural (joined by a central tendon. Costal portion originated from the inner surfaces of ribs 7-12 and the sternum. The crural portion originated from the first three lumbar vertebral bodies)
Q: Name a neuropeptide that acts on pulmonary vascular smooth muscle.
A: Vasointestinal peptide (VIP), neuropeptideV
Q: What is the most common stain used in the determination of the WBC differential?
A: Wright's stain
Studying lymphocyte subsets is important in the diagnosis and follow-up of what type of patient?
AIDS
Acute development of diffuse pulmonary edema that cannot be attributed to cardiogenic factors in adults is known by what label?
ARDS
TB patients transmit infection only when concentration of the tubercule bacilli in their sputum is sufficiently great. What concentration of organisms is necessary to be visible on special stains used to detect these organisms?
About 10 to the 4th/ml
How does the solubility of CO2 compare to that of O2?
About 19 times greater
What percent of patients entering a pulmonary rehabilitation program have already quit smoking?
About 2/3 (68% in one study)
What is the normal fetal PO2 in the descending aorta?
About 22 mmHg
How many times greater affinity does hemoglobin have for CO than for O2?
About 240 times (50% O2Hb and 50% COHb results from a PO2 of 100 mmHg and a PCO of 0.42 mmHg)
According to West, what is the PO2 of the blood leaving the placenta in the umbilical vein?
About 30 mmHg
What is the pressure needed to open a child's balloon to be filled with 500ml?
About 300 cmH2O
How much does CO uptake vary with each gram of Hb?
About 7% (decrease in Hb will decrease DLCO, and increase will increase DLCO)
What other term may be used in place of mass median diameter?
Aerodynamic mass mean diameter (diameter of a sphere of unit density that settles at the same point, when projected horizontally, as the particle being tested)
What do you call a drug or chemical that is able to bind to a receptor and produces a response?
Agonist
What is specific airways conductance?
Airway conductance/ lung volume (usually FRC)
What are the two general output ranges for commonly used ultrasonic nebulizers?
0-3 ml/min (use flat transducer; DeVilbiss 900 & 35, Mistogen 142 & 143, EH147B, Monaghan 650 & 670, Bennett US-1); 0-6 ml/min (Curved focusing transducer; DeVilbiss 800 & 65, Mistogen EN145, Bendix 713, Monaghan 675)
Expressed as mg/kg body weight, what dose of glycopyrollate should be used as an anti-sialagogue?
0.006 mg/kg PO or 0.003 mg/kg IV or IM (atropine - 0.012 mg/kg PO or 0.006 mg/kg IV or IM)
According to Branson, what are the available sizes for oral-pharyngeal airways?
000 to 6
When a pulmonary function parameter requires consideration of only the lower limit of normal, how many standard deviations define the lower limit of normal?
1.65 S.D. (1.96 S.D. is used for "two-tailed" tests to define 95% confidence limits - def. of normal)
What is the normal P50 of a llama?
19 torr
What are the 3 common kymograph speeds and which ones are used to record FVC, MVV, and VE?
1920 mm/min - FVC, 160 mm/min - MVV, 32 mm/min - VE
On an FEV test, how many acceptable efforts are required?
3
What is the molecular weight of Oxygen?
32
Name three instances in which the safety valve will open on the PB 7200.
During POST, if both gas sources lost during operation, if a fault is detected that could harm the patient, if power fails or drops below 90% of the rated power requirement
Continuous recording of what 5 parameters are performed in polysomnography?
EEG (perhaps with eye movement), airflow, motion of abdomen & rib cage, ear oximetry, ECG
In a Severinghaus electrode, what is the buffer inside the teflon jacket?
Bicarbonate
According to Mushin, the respiratory cycle has what four phases?
Inspiration, Expiration, change from expiration to inspiration, change from inspiration to expiration
Triamcinolone acetonide (Azmacort) is available as an MDI preparation and as a suspension for what three routes of administration?
Intramuscular, intraarticular, intrabursal
Fick's law may be expressed as Vx = k (PxA - PxB) x S/T. In this equation, what do you call "k"?
Krogh's constant (the diffusion coefficient multiplied by the solubility coefficient)
Name five products of the lipoxygenase pathway that increase vascular tone, pulmonary smooth muscle tone, and vascular permeability.
LTA4, LTB4, LTC4, LTD4, and LTE4 (different cells produce different mixtures of arachidonic acid metabolites)
Name any three materials which may be used to separate the electrodes from blood in a clark electrode.
Polypropylene (most common), Mylar, Teflon, Polyethylene
What is tank shock?
Pooling of venous blood in the abdomen secondary to negative pressure ventilation
Chronic persistent cough is most commonly caused by what?
Post nasal drip syndrome
What are the 4 most common sites of injury caused by ET tubes?
Posteromedial portion of vocal cords, posteromedial portion of arytenoids, posterolateral aspects of cricoid cartilages, trachea (from rings 3-7)
What do you call a force acting perpendicularly to a surface area?
Pressure
What is the meaning of the term pressure, as applied to a static fluid?
Pressure = height x density (mmHg or cmH2O)
Why might forward displacement of the tongue aid in passing a suction catheter into the trachea during nasotracheal suctioning?
Pulls the epiglottis upward and forward
What does PTE stand for?
Pulmonary Thromboembolism
What is the name of the plant from which the drug ouabain is obtained?
Stratophantus gratus (Digitalis parpurea>digitoxin, gitoxin, gitatoxin; Digitalis lanata> digoxin)
Why should sympathomimetic bronchodilators be used with caution in patients with existing glaucoma?
Sympathomimetics cause mydriasis (dilation of pupil) and vascular dilation which leads to increased fluid, pain, and blindness secondary to damage to optic disc)
Name four of the five major categories of drugs used in the management of asthma?
Sympathomimetics, theophylline, anticholinergics, corticosteroids, cromolyn
Children with sleep apnea may exhibit different signs and symptoms than adults. What are three symptoms?
Labored breathing during sleep, weight loss or FTT, poor school performance, secondary enuresis and behavioral problems
Ephedrine causes CNS stimulation resulting in insomnia and amphetamine-like effects. What feature of this molecule allows it to pass the blood-brain barrier?
Lacks hydroxyl groups on the ring structure (not acted on by COMT, competitively inhibits MAO without destruction)
what nasopharyngeal airway features an Airguide Inflatable Introducer?
Linder Nasopharyngeal Airway
Where in the body is prednisone converted to prednisolone?
Liver
What is the more commonly known name for amyotrophic lateral sclerosis?
Lou Gherig's disease
During a FVC maneuver, dynamic compression of the airways may mask bronchodilator response. What additional measurement may provide documentation of airway responsiveness?
Measurement of airway resistance & calculation of specific conductance
What is the term used to describe the smallest stable unit of any substance?
Molecule (an atom is the smallest unit of matter)
Worldwide, how many deaths occur yearly due to TB?
Nearly 3 million
What is the name of the pear-shaped spacer that improves efficiency of delivery?
Nebuhaler
What is the most abundant atmospheric trace gas?
Neon
What three pollutants are produced in large quantities by internal combustion engines?
Nitrogen oxides, hydrocarbons, carbon monoxide
The Epsworth Sleepiness scale is one evaluative measure that is used to follow treatment effects for what disorder?
OSA
What is the LaPlace equation for spheres?
P = 2 x (T/R)
When evaluating a diabetic patient for intubation, what would a positive "prayer" sign indicate?
Patient is unable to straighten the interphalangeal joints of the fourth and fifth fingers secondary to glycosylation of tissue proteins
What are the six parts of a prescription?
Patient name, address, and date; superscription, inscription, subscription, transcription, name of prescriber
What is the definition of power?
The amount of work done in a given time interval (rate of doing work)
What is the major therapeutic effect of corticosteroids?
The anti-inflammatory effect
Pulmonary TB is most commonly found in what area of the lungs?
The apices
The particle size and spray pattern produced by MDI's are determined by a variety of factors. What is the primary determinant?
The vapor pressure of the canister (others include: size of valve system and actuator orifice, drug concentration, addition of cosolvents)
When using a small volume nebulizer, the quantity of medication remaining in solution in the dead volume is dependent on what factors?
Total volume of solution, nebulizer flow rate, temperature & humidity of the solution, driving gas, entrained gas
What is the standard, FDA-approved, dose of albuterol using an MDI?
Two puffs four times daily (relatively far down on dose-response curve in a moderately severe asthmatic)
What causes a primary increase in cell counts?
Uncontrolled proliferation of cells in the bone marrow
Give 4 examples of systems commonly used to produce PEEP.
Underwater column, water-weighted diaphragm, exhalation valve systems, venturi, spring loaded disk, and magnetic
Pulmonary dysmaturity is commonly known by what other name?
Wilson - Mikity syndrome
What is the range of diameters of gas molecules?
10-8 to 10-7cm
During the infant's first few breaths, intrapleural pressures of what magnitude are typically generated?
-40 to -100 cmH2O
What are the two numbers that can be used to symbolize a bit in a computer?
0 or 1
What are the three general actions by which steroids suppress local or systemic inflammatory response?
1) Upregulates transcription of anti-inflammatory genes 2) Suppression of factors which cause transcription of genes involved in inflammation 3) Upregulation of the expression of inhibitors of HF-xB
At what liter flow does the reimbursement for home oxygen become reduced to 50%?
1 L/m (cost components of home O2: equipment & equipment inventory; setup & educational costs; administration & overhead; delivery, supply & maintenance; O2, liquid or compressed; profit)
If, as advocated in severe adult asthma, albuterol were administered continuously by nebulizer, what range of serum albuterol would be observed?
10-20 ng/ml (nanograms per ml)
The apgar is normally determined at what time intervals following birth?
1 and 5 minutes
In coal worker's pneumoconiosis, what size nodules are associated with complicated pneumoconiosis?
1 cm or more
What is the amount of amniotic fluid at term?
1 liter (about 30ml in early gestation)
What is the output of most large volume jet nebulizers?
1 ml/min (USN - 1-6 ml/min)
Wilkins, et al, state that the effectiveness of a cough is reduced when one or more certain conditions exist. Name four.
1) Weakness of inspiratory or expiratory muscles 2) Inability of the glottis to open or close correctly 3) Obstruction, collapsibility, or alteration in shape or contours of the airway 4) Decrease in lung recoil 5) Abnormal quantity or quality of mucus production
You just performed spirometry on a patient with tuberculosis. What should be done now to prevent cross contamination to the next patient?
1) Wipe all surfaces exposed to exhaled air with detergent while wearing rubber gloves 2) Soak all hoses and the spirometer interior with activated gluteraldehyde for 20 minutes 3) Dry all surfaces
Suppression of the hypothalamic-pituitary-adrenal axis is unusual if the daily dose is below what level?
1,500 ug/day
What is the nebulizer output of mechanical nebulizers?
1-1.5 ml/min (55% 1-5 micrometers) (USN 6 ml/min, 97% 1-5 micrometers, Babington 6 ml/min, 90% 1-5 micrometers)
A device selected for administration of aerosol to the lung parenchyma should produce particle sizes with a MMAD of what size?
1-3 micrometers
According to P & K, what is the optimal particle size for maximum deposition in the lower respiratory tract?
1-5 micrometers
As a complication of artificial airways, what is the incidence of a TE fistula?
1-5%
In California, patients with an FEV1 less than what absolute value are qualified for handicapped parking stickers?
1.0 L
What is normal atmospheric pressure expressed in dynes/cm2?
1.014 x 10 to the 6 dynes/cm2 (others: 1 atm, 760 mmHg or torr, 1034 cmH2O, 29.9 in Hg, 33.9 ft fresh water, 33 ft salt water, 101.33 kPa, 14.7 PSIG)
What is the maximum flowrate of the Bear2 ventilator when operating in the CPAP mode?
100 L/min (120 in chart)
Q: Resting CO2 output is about 240 ml/min. How high can it go in a moderately fit subject during exercise?
A: About 3,000 ml/min
What is the minimum CPAP level that can be obtained with the Respironics BiPAP ST?
2 cmH2O
What is the usual dose and duration given to COPD patients of the antibiotic ampicillin?
2.0gm/day for 10 days (Septra, Bactrim-trimethoprium-sulfamethoxazole, is more effective against Moraxella catarrhalis)
Q: What cartilages sit posteriorly atop the cricoid cartilage?
A: Arytenoids
Q: According to Farzan, where does the lower respiratory tract begin?
A: At the carina
COMT & MAO both work to metabolize catecholamines not inactivated by reuptake. What are catecholamines converted to by COMT & MAO and how is this excreted?
3 methoxy-4 Hydroxymenoelic acid, is excreted in urine
Acute laryngotracheobronchitis (croup) is most commonly seen in what age group?
3 months to 3 years (1-2% mortality)
How long after birth does the anatomical fibrotic closure of the ductus arteriosus take?
3 weeks
What is the boiling point of water in degrees Kelvin?
373
What is the critical temperature of water?
374 degrees Celcius (705 degrees Farenheit)
What is the incidence of post-extubation stridor requiring treatment in healthy children undergoing elective surgery?
4% (as high as 47% in pediatric trauma and burn patients)
How many time constants are required for passive exhalation to be complete?
4 (< 4 = air trapping)
How many tons of chloroflourocarbons are used each year in metered dose inhalers?
4,500 tons (0.4% to 0.5% of annual production)
What is the half life and Gamma emission of Xe?
5.27 days/81 KEV
What is the current understanding of what percent of impotence is due to organic causes?
50 - 75%
What is the incidence of sarcoidosis in Sweden?
64 per 100,000
In 1991, what was the total cost of health care in the U.S?
666 billion dollars (by 2000, estimated this figure will reach 1.5 trillion)
In order to meet minimal spirometry standards for spirometry measuring VC and FVC, what range and accuracy should be present?
7 L plus or minus 3% or 50 mL, whichever is greater
The average smoker inhales how many puffs per cigarette?
7-10
A smoker of 2 packs of cigarettes per day for 20 years is how much more likely to develop lung cancer than a non-smoker?
70 times
What percent of the 50 million Americans who do smoke, report that they would like to quit?
70% (present projections indicate a 15% incidence of smoking by the year 2000)
Clinically significant airflow obstruction is present if the FEV1/FVC ratio is less than what value?
70-75%
In 1991 in the U.S., what was the estimated cost of health care?
740 billion dollars (13.2 billion expenditure for COPD)
Q: What is the meaning of the acronym COP?
A: Colloid osmotic pressure
Q: What is the approximate diameter of the canals of Lambert?
A: 30 m
Q: Approximately how much water can collect in the interstitial space before peripheral edema is clinically evident?
A: 5 liters (the interstitial space is 2/3 of the normal ECF volume. since 2/3 of total body H2O is in ICF and 1/3 is in ECF, 5 liters of H2O must be added to the body for edema to manifest in patients with generalized edematous disorders)
What does AIDS stand for?
Acquired Immunodeficiency syndrome
According to the ideal gas laws, the product of pressure and volume divided by the product of temperature and the number of moles of gas yields a constant, what is the name given to this constant?
Boltzmann constant
When using pressure support for weaning long term ventilator patients, P & K recommend setting the initial pressure level at what value?
Approximately half the PIP, then titrate the level for a RR between 12 & 24
The spinning disk nebulizer is used as a room humidifier. Its operation is based on what principle?
Archimedean screw
What is the third most abundant atmospheric gas?
Argon
At what percent of vital capacity do chest wall elasticity or recoil no longer assist the expiratory process?
At 60% of FVC (from TLC down to approximately 80% of VC, the emptying of the lungs is effort dependent)
What is the mechanism of action of phentolamine and prazosin?
Both are Alpha-adrenoreceptor antagonists; phentolamine affects Alpha1 and Alpha2 (non-selective), and prazosin affects only Alpha1 receptors
According to the AARC clinical practice guidelines, what two sedative antagonists should be available during a bronchoscopy?
Benzodiazepam antagonist (Flumazonil), or narcotic antagonist (Narcan)
In acute leukemia there is a tremendous proliferation of what young cells?
Blasts
On what law is body plethysmography based?
Boyle's law
What is Clark's rule?
Child dose = (child weight in lbs/150 lbs) x (adult dose) , a 70kg (150lb) child gets an adult dose)
What 2 principles influence the deposition of therapeutic aerosols?
Inertial impaction, gravitational settling (sedimentation)
What is the empirical chemical formula for ethylene oxide?
C2H4O
All ventilatory support modes can be classified into one of two broad categories: those that provide full ventilatory support, and those that provide only partial support. According to Egan, what 3 modes provide full ventilatory support?
CMV (control or A/C), SIMV set to deliver a normal breathing rate, PSVmax (partial: low rate SIMV, low level PSV, APRV, BiPAP, CPAP)
What term defines "the sudden loss of skeletal muscle tone in response to strong emotions"?
Cataplexy
What do you call the negative pole of a battery or generator?
Cathode
The technique of intubation depends heavily on the ability to manipulate what 6 anatomical structures?
Cervical spine, occipital joint, mandible, oral soft tissues, neck, and hyoid bone
Name 3 of the 6 materials that strain gauge wires are made from.
Chromium, copper, germanium, nickel, platinum, & silicone
Which chromosome is the gene for CF found?
Chromosome 7
Bitolterol was released as an MDI aerosol in 1985. What is the name of the active form of this pro-drug once it has been converted?
Colterol
What is the name of the "active" form of bitolterol?
Colterol
According to Branson, what are the two contraindications to endotracheal intubation?
Complete airway obstruction, lack of a person trained and experienced in intubation
What is the significance of a PC20 of less than 2 mg/mL?
Consistent with daily symptomatology and may require bronchodilator therapy (20 mg/mL of methacholine to decrease FEV1 < 20% is considered asymptomatic for diagnosis of asthma)
What is the meaning of the term purulent?
Containing or discharging puss
Thalassemia major and thalassemia minor are also known by two other names. Name one.
Cooley's anemia, Mediterranean disease
What was the name of the military fitness expert who originally developed the 12 minute run, later modified for the 12 minute walk with which we are familiar?
Cooper
Supervisors are most heavily involved in which two of the POSDCORB activities?
Coordinating and staffing
Name two curved-tip suction catheter designs.
Coude, Bronchitrac (2 eyes)
What are Dohle bodies?
Cytoplasmic inclusions
Name any two of the species of Datura in which Atropine is found.
Datura stramonium, Datura metal, Datura innoxa (Scopolamine also in this group of belladonna alkaloids, 17th century in India documentation Ayurvedic literature, reached Britain in 1802)
A small subset of patients with severe sleep apnea could be characterized as having Pickwickian syndrome (AKA obesity hypoventilation syndrome). What 5 symptoms does this consist of?
Daytime hypercapnia, daytime hypoxemia, pulmonary hypertension, polycythemia, cor pulmonale
What are patient complaints with hypernatremia?
Excessive thirst and a dry sticky mouth
According to P & K, what is the most common precipitant of reintubation?
Fatigue
What term defines the physical capacity of certain molecules to absorb light and then rapidly re-emit it at a longer wavelength?
Flourescence (because Oxygen quenches or dampens the amount of flourescence, PO2 can be determined by flourescence measurement)
What is the most common general cause of hemoptysis?
Infection
RDS occurs more commonly in what sex?
Males
The association between clubbing and bone and joint disease is known as what syndrome?
Marie(1889)-Bamberger(1890) syndrome
What is defined as the amount of total available demand for an organization's product?
Market penetration
What is Charles' law?
Mass and pressure constant, gas volume varies directly with absolute temperature
What muscles of the body are most affected by steroid use?
Muscles of hips, shoulders, and trunck
What early diagnosis does closing volume reveal?
Obstruction of small airways
What is the second leading cause of social security disability benefits in the U.S.?
Obstructive lung diseases
What is the universal symptom of obstructive SAS?
Olympic class snoring
NOD if most frequently seen and certainly much more profound during what phase of sleep?
REM (rapid eye movement)
What are the three characteristics described by Lewis Thomas in the 1920's as the "Triple response"?
Redness, flare, wheal
According to Poiseuilles law, what is the effect on resistance if the radius of a tube is halved?
Resistance increases by 16 fold
Name two nasopharyngeal airways that incorporate an adjustable flange at the proximal end.
Rusch, Vesta
What are the most common community acquired bacterial pneumonias seen in HIV infected patients?
S. pneumonia, H. influenza
How many membrane spanning segments are contained in a Beta-adrenoceptor?
Seven (coupled to adenylate cyclase through a stimulatory Gs protein)
In what disease would a decreased protein be seen?
Severe liver disease and in severe malnutrition
What is defined as the ratio between the density of a substance and the density of a standard?
Specific gravity
Artificial pneumothorax was used for treatment of what disease?
TB
Name a selective antagonist to Alpha2 receptors.
Yohimbine
According to Rau, particles greater than what size are deposited in the nose and mouth, respectively?
Nose > 10 micrometers, mouth > 15 micrometers (5-10 micrometers early airway generations 1-6, 1-5 micrometers reach lung periphery generations 5-6)
What type of RBCs do not normally circulate in the peripheral blood?
Nucleated
How many people in the U.S. die each year of all causes?
Over 2 million (chronic diseases are the major contribution factor in about 75% of all deaths; COPD responsible for about 79,000 deaths in 1989, & is the 5th leading cause)
In what percent of pleural fluids due to malignancy will cytologic examination be diagnostic?
Over 50%
What is the active ingredient of the nasal sprat known as Afrin?
Oxymetazoline (0.05%)
What is the World Health Organization's definition of health?
"Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity"
According to the AARC, what was the estimated mean cost of home care for ventilator-assisted patients per month in 1984?
$1766
With regard to comparing the efficacy of bronchodilator therapy using different MDI techniques and apparatus, what is meant by "% possible FEV1"?
(pre-post)/(predicted-pre) x 100 = % possible FEV1
According to Branson, what is the MMAD of particles produced by the SPAG?
1.3 micrometers
What is the diameter of the wire in a strain gauge transducer?
25 micrometers
How much humidity should heated humidifiers provide at a temp. of 30 degrees C?
30 mg/L
How much fluid does the nasal mucosa supply to inspired air each day?
About 1 liter
What term denotes the temperature at which the vapor pressure of a liquid equals the pressure exerted by the weight of the atmosphere?
Boiling point
Medical illnesses during air travel are infrequent but most commonly due to what?
Cardiopulmonary disorders
Name the three types of sleep apnea.
Central, obstructive, mixed
Rapid administration of excessive amounts of bicarbonate may lead to what?
Coma or arrhythmia
What is used to confirm proper endobronchial positioning of the double-lumen tube?
Fiberoptic endoscope
What are the four most common causes of ARDS?
Infection, sepsis, aspiration, trauma
In increase in total WBC count is known as what?
Leukocytosis
What was the former name of the FEF200-1200 and what does this maneuver measure?
Maximum expiratory flow rate (MEFR), it measures the average expiratory flow during the early phase of exhalation (specifically, it measures the flow rate for the 1000 mL of expired gas immediately following the first 200 mL of expired gas)
The FEF25-75% was formerly known as what?
Maximum mid-expiratory flow rate (MMFR, or MMEF)
What is different about an immune compromised patient's sputum?
May not have large numbers of leukocytes in sputum even in the presence of infection
Why is it important to add a volume of diluent to a nebulizer?
Nebulizers have a volume fill requirement (needed for neb efficiency)
What microbes are normally found in meconium?
None
Whose law is expressed as "electromotive force equals current times resistance"?
Ohm's law (volts = amps x ohms)
What condition is caused by the ova and flukes of schistosomiasis lodging in the pulmonary circulation?
Parasitic embolism
With regard to the Medicare program, what two groups of people receive benefits?
People over 65 years of age and people who have been 100% medically disabled for 2 consecutive years regardless of their age
What are the three basic phases of drug action?
Pharmaceutical, pharmacokinetic, pharmacodynamic
What term is synonymous with reproducibility and is a measure of the reliability of measurements?
Precision
What do the initials RAST stand for?
Radio-Allergo-Sorbent Test
Whose name is associated with the development of the clinical PCO2 electrode?
Severinghaus
What are the four lung capacities?
TLC, FRC, IC, VC
Name the three general types of volume spirometers.
Water seal, bellows, dry rolling seal
What is the maximum expiratory pressure that can be achieved at residual lung volume?
Zero
Who coined the term "mucokinetics"?
Ziment (mucolytics and expectorants)
In normal infants, the entire pulmonary circulation is considered to be in what zone from a functional standpoint?
Zone III
In the infant, what are the angles of the left and right main stem bronchi?
about 55 degrees with the vertical axis
How are temperatures expressed in Farenheit converted to Rankin?
degrees F + 460
Microorganisms are able to multiply to high concentrations in the stomach when the gastric pH reaches what value?
greater than or equal to 4
Identify the law of physics that may be described as "in any mechanical process, there will always be a decrease in the total energy available to do work"?
2nd law of thermodynamics (1st law - energy is neither created nor destroyed...)
Expressed in grams per mole, what is the density of oxygen?
32 g/mol (CO2 density = 44 g/mol, O2 viscosity = 201 micropoises, CO2 viscosity = 148 micropoises)
One pound of liquid O2 will generate how many liters of gaseous O2?
342 L
What is the barometric pressure and PIO2 at 14,000 feet?
450 mmHg, 80 mmHg
Oxygen in an air mixture exerts how much partial pressure at a depth of 66 feet of sea water?
479 mmHg
How many ATA's are required to deliver 1 ATA of pure O2 using a gas mixture of 20% O2?
5 ATA
In acute respiratory alkalosis, the plasma bicarbonate decreases .2 mEq for every torr decrease in PCO2. How much will the bicarbonate decrease in chronic respiratory alkalosis for each torr decrease in PCO2?
5 mEq
How many grams of nitrogen are contained in each 100 grams of protein?
6.25 g/100g protein
What term is used to describe the temperature at which a gas mixture becomes saturated with water vapor?
Dew point
What do you call a monosaccharide that has five carbons in its chain?
Pentose (3 = triose, 4 = tetrose, 6 = hexose)
What is meant by the term "ambient conditions"?
Room (prevailing) conditions
What term describes the direct change of state from a solid to a gas without going through a liquid phase?
Sublimation
According to P & K, when does lung development begin?
24 days gestation
According to Hodgkin, how many alveoli are present at birth?
24 million
How many standard waveforms should the test signals used to calibrate a spirometer for flow rates include?
24 standard waveforms
At a pH of 7.40, what is the normal buffer base of blood?
48 mEq/L
Under standard conditions, how many molecules of any ideal gas will it take to occupy 22.4 liters?
6.023 x 10 to the 23 molecules
What is the Jinotti?
A closed suction oxygen insufflation catheter
Pulmonary hemorrhage occurs most commonly in what age group?
Neonates
Name any three reversible cholinesterase inhibitors that act as parasympathomimetics.
Neostigmine (reverses curare & treats MG), edrophonium (test for MG), pyridostigmine, ambenonium, demecarium
Whose equation is used in a pH electrode to describe the relationship between voltage and pH?
Nernst (modified Nernst equation)
What is the influence of smoking on the development of mesothelioma in individuals with asbestos exposure?
No effect
What is the classic appearance of the CXR in infants with RDS?
"Frosted glass), reticulogranular infiltrates distributed throughout the lung fields)
What is the density of carbon dioxide?
1.973 g/L
How many people quit smoking each year?
1,000,000 (10-20% seek help from programs)
How many milliliters of water are delivered to the airway surface with a typical 10-20 min. bland aerosol treatment by mechanical nebulizer?
1.2 ml (0.5-1.0 ml/min output from mechanical nebulizers as compared to 3-6 ml/min from ultrasonics)
Expressed in inches, what is one micron?
1/25,000 of an inch (1/1,000 of a mm)
Breathing room air at sea level, what percent of alveolar gas is oxygen?
13.7%
For a flow-volume curve, what ratio between the flow to volume scales should be maintained?
2:1
The fan speed on a USN produces a flow of approximately how many L/min?
30 L/min
What is the minimum flow required when using the nebulizer control on the Bear2?
30 L/min
What is the internal preset pressure pop-off on the Bourns LS150
30 cmH2O
What is the temperature of the nasal mucosa at end inspiration?
31 degrees C
According to the American Society for Testing and Materials, what should the pop-off pressure be for infant and pediatric resuscitator bags?
40 cmH2O
At what pressure is the test breath delivered during VS on the Servo 300?
5 cmH2O (max change in PIP = 3 cmH2O/breath)
What percent of patients with lung cancer are cigarette smokers?
90%
In computer language, what do you call a binary picture element?
A pixel
What is the Kelvin scale?
A temperature scale based upon absolute zero and calibrated in Celsius units
What is the Rankin scale?
A temperature scale based upon absolute zero and calibrated in Fahrenheit units.
What is a watt?
A unit of power which equals 1 joule per second
Q: What are the three chemical components that make up an ATP molecule?
A: Adenine, Ribose, Phosphates (3)
How are temperatures expressed in Celsius converted to Kelvin?
Add 273 to celsius temp to get Kelvin
Name any two of the three ways of adjusting a spirometer following a calibration.
Adjust the analog output signal from the primary transducer, adjust the sensitivity of the recorder, software correction or compensation
How will the addition of water vapor to a dry gas mixture affect the partial pressures of the constituent gases?
All partial pressures will decrease proportionally
What is the meaning of the term congestion?
An excessive accumulation of blood in the vessels of an organ
Define density.
An expression of the mass of an object per unit of volume
What is polycythemia and what are the 2 types?
An increase in RBC count, hemoglobin, and hematocrit; primary or secondary types
What is Bernoulli's principle?
As forward velocity of a gas increases, its lateral pressure decreases with a corresponding increase in forward pressure
The addition of one-tenth part of venous blood to an arterial blood sample could result in what percent drop in measured PaO2?
As much as 25%
In what part of the lung is absorption atelectasis most likely to occur?
At the bottom portion (gravity dependent)
What is the MMAD of most MDI's?
Between 3-6 micrometers
Apart from liver disease, the other main category for which ALP determinations are useful clinically is what?
Bone diseases
How is the proper size of an oropharyngeal airway estimated?
By placing it along the cheek and measuring the distance from the corner of the mouth to the tragus of the ear
In what 2 ways is PEEP effective in treating cardiogenic pulmonary edema?
By reversal of capillary shunt, decreased venous return may increase cardiac performance
Name two herpes viruses that may cause pneumonia in immunodeficient patients.
CMV, varicella-zoster, herpes-simplex
What 5 extrapulmonary elements may contribute to respiratory failure?
CNS, peripheral nervous system, chest wall, muscles, upper airway
What are the diagnostic clinical manifestations of chronic bronchitis?
Cough and increased sputum production for at least 3 consecutive months each year for 2 consecutive years
Name the 3 sites of origin of airborne pathogens.
Cough from an infected person, from soil or water aerosolized by wind, from other animals
Name any 4 of the common and important symptoms of respiratory diseases listed by Farzan.
Cough, expectoration, dyspnea, hemoptysis, chest pain, wheezing
What term describes the particle size above and below which 50% of the particles are found?
Count median diameter (CMD) - 50% of the particles in the distribution are larger than the count median diameter and 50% are smaller
Who manufactures the Cuff-Mate?
DHD Medical Products (Cuff-Gauge - Intermed)
What non-narcotic cough suppressant is most suitable for a COPD patient with a constant, irritating, non-productive cough?
Dextromethorphan
What is another name for the drive mechanism that uses an electric motor with a rotating crank and piston rod?
Eccentric wheel
Within the first 12 days following fertilization of the egg(zygote) and implantation into the wall of the uterus, the three primary germ layers develop. Name them.
Ectoderm (develops into brain & CNS), mesoderm (vasculature, bones, muscle), endoderm (heart, liver, lungs)
What two mechanisms are required for normal secretion clearance?
Effective mucociliary transport, effective cough
What kind of dyspnea do most people with cardiopulmonary disease exhibit?
Exertional dyspnea
What are the 4 types of flow-sensing spirometers?
Fleisch pneumotachometer, metal screen, disposable screen, vortex shedding
What do you call the process of establishment of assumptions about the future?
Forecasting
When is it nonproductive to use the tuberculin test?
Foreigner vaccinated with BCG vaccine (bacille Calmette-Guerin), and those who have already had TB
Who was the psychiatrist who named "gallows humor"?
Freud
What term defines the measure of the variability of the particle diameters within an aerosol?
Geometric standard deviation (the higher the GSD, the more larger & smaller particles are present)
How do hydroflourocarbons differ from chloroflourocarbons?
HFC's do not contain chlorine, have a higher vapor pressure, and a lower solubility the CFC's
What does HFFI stand for?
High Frequency Flow Interruption (Emerson - %TI fixed at 30%, frequency at 110-200 cpm)
Name three mechanical systems capable of delivering high-frequency ventilation and the range of frequencies delivered.
High-frequency positive pressure ventilation (60-100 b/min), high-frequency jet ventilation (60-200 b/min), high-frequency oscillation (600-3000 b/min). (Egan says 60-100, 100-200, and 60-3600 respectively)
Name 4 of the 7 causes of exudative pleural effusions as stated by Farzan.
Infections (bacterial, fungal, viral), neoplasms (primary, metastatic), trauma & surgery, systemic disease (lupus, rheumatoid arthritis), intraabdominal disease (pancreatitis, subdiaphragmatic abscess), idiopathic
What is the unique feature on the Inspiron Vapor Phase humidifier?
Hydrophobic filter (allows no microbial penetration)
What term means an accumulation of watery fluid in pleural cavity?
Hydrothorax or pleural effusion
What is produced when a metal ion such as iron or copper is present with a hydrogen peroxide molecule?
Hydroxyl radicals (OH=)
What disease, primarily seen in young children, is similar to Goodpasture's syndrome except there is no kidney lesion?
Idiopathic pulmonary hemosiderosis
What is Gay-Lussac's law?
If mass and volume are constant, gas pressure varies directly with absolute temperature
When does disconnect ventilation occur on the PB7200?
If the delivery pressure exceeds the pressure limit or if the drive pressure exceeds PEEP plus 30 cmH2O while the patient pressure is sensed as ambient
The fetal lung is not air-filled and is not collapsed. What is its status?
Inflated to about 40% of TLC (at FRC)
Which of the immunoglobins is referred to as "cytophilic antibody"?
IgE
If a COPD patient with a stable PaO2 on room air of 60mmHg were to take an airline flight without supplemental O2, what PaO2 would you expect during the flight?
In the 30's (domestic airlines can supply O2 by mask at 2-4 L/min, empty O2 cylinders can be checked as baggage; airlines require 24-72 hours notice and physician medical certificate)
One of the mechanisms by which a Beta2-agonist drug promotes the relaxation of bronchial smooth muscle is by decreasing intracellular calcium. What is the other mechanism?
Inactivates the myosin light chain kinase
Name 5 of the 6 indications for mechanical ventilation as listed by Egan.
Inadequate alveolar ventilation, inadequate lung expansion, inadequate respiratory muscle strength, excessive WOB, unstable ventilatory drive, severe hypoxemia (special uses cited: closed head injury)
Name any 4 common computer input devices.
Keyboard, mouse (or trackball), optical scanner, digitizing pad, analog-to-digital converter (ADC), bar-code reader, pen-based system
In what units is body-mass index expressed?
Kg body weight/body surface area in mm squared
What quantity is described as the amount of work required to move a 1 kg mass a vertical distance of 1 meter against the force of gravity?
Kilopond meter (kpm)
What term describes the degree of constant molecular motion?
Kinetic activity (energy)
What term describes the elevation of the WBC count?
Leukocytosis
A decrease in total WBC count is known as what?
Leukopenia
Give an example of a class I antiarrhythmic agent.
Lidocaine (class IA - Procainamide - prolongs repolarization time, class IB - Lidocaine - shortens repolarization time, class IC - Flecainide)
What is the meaning of the term idiopathic?
Of unknown origin
In analyzing the single-breath DLCO test, what is the difference between the Ogiline and the Meade-Jones method of estimating the time of breath-hold?
Ogilive measures from beginning of inspiration to beginning of alveolar sampling; the Meade-Jones measures from 2/3 of inspired VC to mid-point of alveolar sample
How many Americans are alcoholics?
Over 10 million
What percent of the cases of lung cancer show evidence of metastasis at the time of diagnosis?
Over 50%
What is the most abundant atom at the earth's crust?
Oxygen
What chemical reaction takes place at the cathode of a PO2 electrode?
Oxygen + water + electrons --> Hydroxyl ions (O2 + 2H2O + 4e- --> 4OH-)
BPD is believed to result from the combination of what two entities?
Oxygen toxicity, positive pressure ventilation
What is the name given to the condition in which arterial blood oxygen content is normal but cyanosis is present with a diminished peripheral blood flow?
Peripheral cyanosis (central cyanosis - arterial blood oxygen is low)
Name four types of compressors commonly used inside ventilators.
Piston & cylinder (Emerson IMV), Diaphragm (Engstrom Erica), Bellows (Servo 900C), Rotating vane (Bear 2)
What do you call a thin-walled, air-filled cyst occuring in lung tissue?
Pneumatocele
List 2 causes of increased serum chloride.
Prolonged diarrhea (loss of HCO3-), kidney disease, hyperparathyroidism
What does the term pharmacognosy mean?
Recognition of the sources of drugs
Name the 3 classifications of nebulizers.
Sidestream, mainstream, slipstream
In addition to using a calibrated large-volume syringe, name three other devices which can be used to generate the signal for quality control?
Sine-wave rotary pump, automated syringe, explosive decompression device, biologic control
What concept is negative pressure ventilation based on?
Spontaneous breathing
Name a depolarizing muscle relaxant.
Succinylcholine
What type of person did Tom Petty refer to as "someone who is long-winded about the short-winded"?
The academic pulmonary physician
What is Rohrer's equation?
The equations relating P and V under laminar and turbulent flow are combined. (change in P = [k1 x V1] + [k2 x V2])
Define the term "accuracy".
The extent to which measurement of a known quantity results in a value approximately that quantity
Define the term "precision".
The extent to which repeated measurements of the same quantity can be reproduced
What is the meaning of the term infarction?
The formation of an area of necrosis as a result of ischemia
As an objective, what does the term "leadership" mean?
The goal to demonstrate increased importance in an industry
What term describes the tendency of a performance evaluator to allow one facet of a person's character or performance to influence all other ratings?
The halo effect
What is the most common source of leaks in the patient-ventilator interface?
The humidifier (2nd - exhalation valves)
What is the diffusion coefficient of a gas?
The ml of a gas that will diffuse a distance of 1 micron over a square cm surface per minute
The oral pediatric Rae tube is designed so that the outer portion of the tube rests on what anatomical surface?
The patient's chin (nasal - patient's forehead)
According to Egan, an HME should operate at 70% efficiency. Define efficiency.
The ratio of the absolute humidity of exhaled gas to the humidity returned to the patient by the HME
What is the phase of pharmacology which describes the way by which a drug dose is made available to the body?
The pharmaceutical phase
What term describes a decreasing intensity of response to a drug over time?
Tolerance
In a solution, what term describes the medium into which the solute is dissolved?
The solvent
What is the rationale for accepting the largest value observed rather than the mean for the results of a PFT?
The subject cannot overshoot on a test that is effort dependent
What is dew point?
The temperature at which air with a given absolute humidity becomes saturated
Define dew point.
The temperature at which water vapor condenses back to its liquid form
What is absolute zero?
The theoretic temperature at which all molecular activity ceases (-273 C)
Describe proportional assist ventilation.
The ventilator responds to each patient effort as well as the compliance and resistance of the system. PAV amplifies patient effort while leaving the patient entirely in control of all aspects of breathing. Thus, pressure, volume, time, and flow may vary from breath to breath
What concern limits the use of USNs for delivery of aerosol medications?
The vibratory energy of the high frequency waves disrupts the chemical structure of the medication
Precisely what is meant by the term solubility coefficient?
The volume of a gas that will dissolve in 1 ml of a given liquid at standard pressure and a specified temperature.
In performing a plethysmographic VT test, how many acceptable panting maneuvers should be obtained?
Three whose angles agree plus or minus 10% of the average of the angles measured
What is the objective of spirometry?
To assess ventilatory function
For exercise and metabolic studies, how accurate should the gas analyzer be?
To at least two decimal places (1/100 of a percent)
What is the goal of pulmonary rehabilitation?
To improve the quality of life of patients with chronic lung disease by increasing their functional capacity and sense of well-being
What is the primary goal of home care?
To prevent or reduce acute care hospitalizations
On leaving the placenta, the arterialized blood is routed to the liver where a portion of it enters via the portal sinus. Where does the remaining blood travel?
To the inferior vena cava by way of the ductus venosus
In a normal subject, when the VC and the FVC are compared, how closely should they agree?
To within 5% (if VC < 95% of FVC, then poor subject effort; if VC > FVC by a significant amount, then dynamic compression of airways during FVC)
Name any five of the six modifiable factors for the top causes of death in the U.S.
Tobacco use, hypertension, elevated blood cholesterol, poor nutrition, physical inactivity, heavy alcohol use (elimination of any one factor could reduce mortality by 47%)
What do you call the decreasing intensity of drug response over time?
Tolerance
Of the six types of capsulated H. influenzae organisms, which type is the most common and virulent?
Type B
In the early stages of ARDS, what cells in the AC membrane are damaged, causing capillary leak?
Type I pneumocytes
What is a bell factor used for?
Used to convert vertical distances measured in millimeters on graph paper to volume in millimeters. The bell factor is equivalent to the volume contained in a cross-sectional area of the bell
What is the purpose of the "oxygen challenge test" for neonates?
Used to distinguish between cardiac and respiratory disease
How should the known volume syringe be checked for accuracy and how often?
Using a second known volume syringe with the spirometer in the patient-test mode; check at least quarterly
What do you call the activity that determines if physicians are utilizing the hospital effectively and efficiently?
Utilization review
Finucane lists five indications for intubation. Name four.
Ventilatory support, protection of the airway, ensuring airway patency, anesthesia and surgery, suctioning
The spinhaler is used for the administration of cromolyn sodium. What drug is administered with the rotahaler?
Ventolin
What type of PEEP system is employed on the PB 7200?
Venturi
What is the gold standard for verifying proper ETT position following intubation?
Verify presence of end-tidal CO2
State Fick's law of diffusion.
Vgas = {(A x D)/T}(P1 - P2) where A = area, D = diffusion coefficient, T = thickness, (P1 - P2) = pressure gradient across membrane
What types of disorders is lymphocytosis seen?
Viral infections, especially monomucleosis
What is the most common and clinically significant cause of acute cough?
Viral tracheobronchitis
What is the most useful index for following pathologic changes in the alveolar region secondary to O2 toxicity?
Vital capacity
What does VAPSV stand for?
Volume Assured Pressure Support Ventilation (Bear1000 - pressure augmentation, Brid8400sti - VAPS)
What is flow?
Volume change per unit time
Velocity is the speed of movement between two points, usually expressed as miles per hour or centimeters per second. Define flow.
Volume of fluid passing a single point per unit time
How will an increase in temperature of 1 degree F affect a volume of 1 liter of gas?
Volume will increase by 1.88ml
Of all the gases common to respiratory physiology, which one does not conform to the ideal gas laws?
Water vapor
In what units is the consumption of electric poser measured?
Watts (watts = volts x amps)
What is the most commonly used cognitive assessment test?
Wechsler Adult Intelligence Scale - Revised
The diaphragm develops during what gestational age?
Week 7
What pulmonary vasculitide is characterized by necrotizing granulomas along the blood vessel walls, usually afflicts patients in the fourth to sixth decades of life and has a slightly male predominance?
Wegener's granulomatosis
What term is defined as the product of mass and the acceleration of gravity?
Weight
Name 4 of the 7 systemic or extrathoracic symptoms of lung cancer according to Farzan.
Weight loss, anorexia, weakness or fatigue, bone & joint pain, swelling of face & arms, hoarseness, various neurologic symptoms
What type of stain is used for CBC differential?
Wright's stain
The most common type of computer optical disk is the WORM. What does the term WORM mean?
Write Once Read Many
What is microcytic, hypochromic anemia?
When anemia is present and the MCV, MCH, and MCHC are abnormally low (RBCs are smaller than normal and contain a lower than normal Hb concentration
Under what circumstance is applied PEEP and auto-PEEP additive?
When auto-PEEP is a result of inadequate expiratory time without concomitant dynamic airflow obstruction (additive effect occurs because there is no alteration in dynamic airflow limitation as external PEEP is applied. If auto-PEEP is a result of dynamic airflow obstruction, the applied PEEP may decrease auto-PEEP by improving gas distribution and decreasing transpulmonary pressure differential during exhalation)
If the temperature were to increase from 37 degrees Celcius to 39 degrees Celcius, what would happen to the PaCO2 which was 40mmHg at 37 degrees Celcius?
it would rise by 10% to approximately 44mmHg
What are three assumptions that describe an "ideal gas"?
1) no energy is lost during collisions between gas molecules 2) the volume actually occupied by gas molecules is negligible 3) no forces of mutual attraction exist between gas molecules
Expressed in degrees centigrade, what is the boiling point of oxygen?
- 183 degrees Celcius
What is the specific gravity of air?
1 (O2 = 1.1049)
For individuals with normal lungs, how much will PaCO2 be reduced for each mEq/L reduction in bicarbonate?
1.2 mmHg (0.6 increase for each increase of 1 mEq/L increase in bicarb)
What conversion factor would you use to convert mmHg to dynes/cm2?
1335 dynes/cm2/mmHg
What temperature and pressure is referred to as standard conditions?
760 mmHg and OC (273 K)
In a diesel engine, no spark plug is needed because the compression of the diesel vapor causes heating in the compressed gases. What term describes the change in temperature which accompanies either compression or expansion?
Adiabatic
What is a potentiometer?
An instrument that measures an unknown voltage by comparing it with a known reference voltage.
What is the Pitot principle?
An open-ended tube is forced in the direction of flow from the jet orifice so that the end pressure is equal to the lead pressure as a result of air velocity.
What is the body's most abundant cation?
Calcium ++
How are Latin and Greek prefixes used respectively to modify the primary units?
Latin prefixes are used for units smaller than the primary unit and Greek prefixes are used for units larger than the primary unit.
The yellow haze of smog is due primarily to what type of atmospheric pollutants?
Nitrogen oxides
What is Graham's law?
The rate of diffusion of a gas is inversely proportional to the square root of it's density or its gram molecular weight
What is Henry's law?
The weight (amount) of gas dissolving in a liquid at a given temperature is proportional to the partial pressure of the gas.
Carefully define a gram.
The weight of 1 ml of distilled water at 4 degrees C
In ascending order, what are the four layers of the atmosphere?
Troposphere, stratosphere, ionosphere, exosphere
What value is derived from the negative logarithm of 40 x 10-9
p H of 7.4
A forced expiratory maneuver can be simulated in neonates by wrapping and inflatable cuff around the chest and abdomen and pressurizing it at end of inspiration. What colorful term has been given to this technique?
"Squeezing the wheeze" (the cuff is inflated rapidly from 40 to 80 mmHg)
In terms of numbers of people receiving social security disability payments for their disease process, what are the number 1 & 1 diseases?
#1 Coronary heart disease, #2 COPD
In the U.S., what is the approximate cost per month to supply electricity to run an oxygen concentrator?
$35/month
Describe the formula to determine vascular resistance.
(Input pressure - output pressure)/blood flow
What is the range of inspiratory effort required to open most one-way valves used in open circuit IMV systems?
-0.5 to -2 cmH2O
What is the critical temperature of oxygen?
-183 degrees Celcius (-297 degrees Farenheit)
At what temperature does O2 become a liquid?
-183 degrees Celcius (below it's boiling point)
At what rate, in ml/year, do COPD patients decrease their FEV1?
-60 to -120 ml/year (-30 ml/year over 30 for normal population)
When evaluating a patient for extubation, a negative indicator is the absence of a gag reflex. What number of healthy subjects do not exhibit a gag reflex?
1 out of 5
What is the range of possible scores with the apgar system?
0-10
What flow-range should a spirometer be capable of recording to meet minimal spirometry standards?
0-12 L/sec
What is the solubility coefficient of Oxygen in plasma at 37 degrees Celcius and 760 mmHg?
0.023 ml (for CO2 = 0.510 ml; the solubility coefficient used in the calculation of O2 content due to dissolved O2 in plasma is 0.003 and is based on 100 ml of plasma and 1 mmHg pressure at 37C)
At 37 degrees Celcius and 760 mmHg pressure in plasma, what are the solubility coefficients for oxygen and carbon dioxide respectively?
0.023 ml/ml for Oxygen, and 0.510 ml/ml for Carbon Dioxide
During exercise tests for subjects breathing room air, what range should the O2 analyzer be calibrated to?
0.12 to 0.21 (eg: room air and 12% O2 would be the two test gases used to calibrate the oxygen analyzer)
What is the conversion factor from millimeters of mercury to kilopascals?
0.133 (PaO2 of 80-100 - 10.6-13.3 kPa, PaCO2 of 35-45 = 4.6-6 kPa)
A tension time index above what value is indicative of a potentially fatiguing pattern of ventilation?
0.15
How much pirbuterol is released from the MDI canister per puff?
0.2 mg/puff or 200ugm (300 inhalations/canister, produced by 3M Pharmaceuticals --has a peridine ring instead of benzene ring, onset of 5-8 min, peak effect 30 min, duration 5 hrs)
What is the usual dosage when administering epinephrine subcutaneously in acute asthma?
0.3 mg (0.3 ml of 1:1000 Epi Q15-20 min), up to 1mg in 2hrs (Terbutaline - 0.25 mg, 0.25 ml of 1mg/ml solution, repeated in 15-30 min up to 0.5 mg in 4hrs)
What is the risk of HIV infection following puncture with a contaminated needle?
0.3% (6-30% for hepatitis B)
In a chronic respiratory acidosis, how much will the plasma bicarbonate increase for every torr increase in the PCO2?
0.35 mEq/L
What is the optimum TI/Ttot (duty cycle) for patients with airflow obstruction when using PCV?
0.37
During pressure control ventilation of patients with airflow obstruction, what is the optimum dutycycle (TI/Ttot)?
0.37 (37% TI)
If a sealed 1 liter bag of air is placed into a hyperbaric chamber and compressed to 2 ATA how much space would it now occupy?
0.5 L
What is the internal resistance of the LP6 Plus?
0.5 cmH2O (vs LP6 = 1.0 cmH2O)
What is the range of normal for carboxyhemoglobin expresses as percent of normal hemoglobin?
0.5 to 2.0% (increased to between 3 and 15% in smokers dependent on recent smoking history)
According to Branson, who makes the only HMEF device?
0.7 mm/sec
For a 5 um particle, what is the settling rate due to gravity?
0.7 mm/sec (rate of settling is proportional to the square of the particle size)
What is the density of a gas mixture containing 50% oxygen and 50% helium?
0.804 g/L
If you wanted to give glycopyrrolate (Robinol) by nebulizer, what dose would you place in the nebulizer and how often would you give it?
1 mg Q6H
How long following smoking cessation will symptoms of cough and sputum production improve?
1 month
What is an Emole?
1 x 1018 moles
What three criteria identify an acceptable MVV?
1) 12 seconds or more of continuous rhythmic effort without change in end-expiratory volume 2) At least 2 acceptable maneuvers should be obtained (results should not be > 10% different) 3) MVV should approximate FEV1 x 35
According to the AARC CPGs, what 4 conditions for bronchoscopy are usually considered absolute contraindications unless the risk-benefit assessment warrants the procedures?
1) Coagulopathy or bleeding diathesis that cannot be corrected 2) Severe obstructive airway disease 3) Severe refractory hypoxemia 4) Unstable hemodynamic status including dysrhythmias
Name the 3 types of HME's.
1) Condenser - allow exp. water vapor to condense onto the cool surface of the condenser, usually metallic gauze, corrugated metal. Provides high thermal conductivity 50% efficiency 2) Hygroscopic condenser - made from paper, wood, or foam - low thermal conductivity, material impregnated with calcium chloride or lithium chloride to help absorb more water on exhalation, 70% efficiency 3) Hydrophobic condenser - uses a water repellent element with a large surface area and a low thermal conductivity so that heat from conduction and latent heat of condensation is not dissipated, 70% efficiency
According to the American Thoracic Society's Position Statement of 1981 on Pulmonary Rehabilitation, what are the two major objectives of pulmonary rehabilitation?
1) Control and alleviate, as much as possible, the symptoms and pathophysiologic complications of respiratory impairment 2) Teach the patients how to achieve optimal capability for carrying out his/her activities of daily living
According to the AARC CPG what are the 6 indications for spirometry?
1) Detect presence or absence of lung dysfunction suggested by Hx or other tests 2) Quantify severity of lung disease 3) Assess changes in lung function following therapy 4) Environmental or occupational exposure effect 5) Surgical risk 6) Disability (legal reasons)
What are the objectives of metabolic measurements by indirect calorimetry according to the AARC-CPG's?
1) Determine REE of mechanically vented patients to guide appropriate nutritional support 2) Determine RQ to allow tailoring of nutritional regimens to patient needs 3) Determine REE & RQ to monitor adequacy of nutritional support 4) Determine substrate utilization 5) Determine O2 cost of breathing 6) Monitor VO2 as a guide to targeting adequate DO2
Name the four phases of lung development.
1) Embryonic period (fertilization week 5: primitive lung bud, trachea, main stem bronchus) 2) Pseudoglandular ( 5-16 weeks: pulmonary arteries/veins, mucus glands, goblet cells, diaphragm, lung lobes) 3) Canalicular ( 17-24 weeks: resp. bronchioles, alveolar ducts, type I and II cells, surfactant synthesis begins) 4) Terminal sac (25weesks - birth: Alveoli increase to 24 million, surface area 2.8 m2)
Name any 4 of the 7 types of patients who would be considered potential candidates for home care.
1) Have repeated hospitalizations (the "revolving door" patient) 2) Newly diagnosed or hospitalized for the first time 3) Patients who are anxious, confused, or forgetful and require medications or treatments 4) Going home with new respiratory equipment 5) Stable patients who develop an exacerbation that their physician wants treated at home 6) Patients requiring brief follow-up after a formal rehabilitation program 7) End-stage terminal patients who want to stay at home
In order of decreasing incidence as the cause of death, list five leading causes of death in the U.S. in 1990.
1) Heart disease - 33.5%, 725,000 deaths 2) Malignancy - 23%, 506,000 deaths 3) Cerebrovascular - 6.7%, 145,000 deaths 4) Accidents - 4.3%, 93,500 deaths 5) COPD - 4.1%, 88,900 deaths (3.6% direct, additional contributing factor in 4.3%)
What are 7 relative contraindications to performing spirometry according to the AARC CPGs?
1) Hemoptysis of unknown origin 2) Pneumothorax 3) Unstable cardiovascular status (recent MI or PE) 4) Thoracic, abdominal, or cerebral aneurysms (danger of rupture) 5) Recent eye surgery 6) Acute disease that may interfere with test performance (nausea,vomiting) 7) Recent surgery of thorax or abdomen
Name 4 of the 5 general categories that according to the CDC are potential risk factors for nosocomial bacterial pneumonia.
1) Host factors such as extremes of age and severe underlying conditions, includes immunosuppression 2) Factors such as antimicrobial use, ICU admission, underlying chronic lung disease, or coma that enhance colonization of the oropharynx 3) Conditions favoring aspiration or reflux (ETT, NGT, supine position) 4) Mechanical vent use, potential exposure to contaminated respiratory therapy equipment, contact with contaminated or colonized hands of workers 5) Factors that impede pulmonary toilet - surgical procedures of head and neck, thorax, upper abdomen, and immobilizations due to trauma or illness
Name 3 of the 4 different types of hygrometers.
1) Hygroscope - uses hygroscopic chemical to absorb water vapor, RH is determined by weighing 2) Electric - uses transducing element whose electrical properties are determined by water vapor content 3) Diffusion - measures diffusion of water through porous membrane 4) Spectral - measures absorption spectra of water
Name any two of the three general approaches among investigational beta-adrenergics to augment the duration of action.
1) Increase number and size of lipid soluble groups to enhance receptor binding (ex: formoterol) 2) lengthen the side chains to promote attachment to sites next to the beta-receptor Salmeterol 3) Develop a pro-drug for sustained activation of the agonist moiety - babuterol
List any four causes of failure of fiberoptic intubation.
1) Lack of training and experience 2) Unprepared patient (inadequately educated/informed, insufficient topical anesthesia, inadequate sedation) 3) Excessive secretions or blood 4) Distorted airway anatomy 5) Masses, tumors, cysts 6) Can't pass tube over scope
List any 4 complications of fiberoptic intubation.
1) Laryngospasm/bronchospasm 2) Vomiting (potential for aspiration) 3) Hematoma at site of transtracheal injection of local anesthesia 4) Oversedation (hypoventilation and hypoxemia) 5) Potential for barotrauma secondary to Oxygen insufflation 6) Endoscope damage (usually expensive!) 7) Patient recall of the intubation process
Name any 4 of the 5 items that should be in written quality assurance program.
1) Method employed for specific tests 2) Limitations of the procedure (if any) 3) Indications or schedules for maintenance 4) Action to be taken if controls exceed specified limits 5) Specific guidelines as to how tests are to be performed
Name any 4 of the 6 1994 ATS standards for spirometry.
1) Minimum graph 2) Daily calibration for volume and flow spirometers within 3% accuracy 3) Daily leak check for volume spirometers, no change after 1 minute 4) Quarterly speed check for volume spirometers with 1% accuracy using a stopwatch 5) Less than 1.5 cmH2O/L/sec back pressure 6) Temp. measured in spirometer within 1 degress C for each patient (test between 17 degress C and 40 degress C)
In order to get reimbursed under Part B of Medicare for replacement transtracheal catheters, what three conditions have to be established?
1) Patient must have medical problem related to nasal cannula use (remains hypoxemic at highest tolerable flow rate) 2) Patient must derive significant increase in ambulation 3) Prescribing physician must document 1 & 2 above
Name two effects of PAF activation.
1) Platelet aggregation and degranulation 2) Neutrophil and mononuclear cell chemotaxis and activation 3) Stimulates release of prostaglandins, thromboxane A2, and leukotrienes 4) Augments neutrophil-endothelial cell adhesion, increases vascular permeability and promotes pulmonary smooth muscle contraction
What are six significant disadvantages of delivering drug by aerosol?
1) Requires special equipment 2) Patient must be cooperative (unless intubated) 3) Precise drug dosages are difficult to achieve 4) Only a small proportion of the drug is retained in the lung 5) Oropharyngeal deposition results in systemic absorption 6) Oropharyngeal irritation
Name the three protocols used for inhalation drug challenge testing.
1) Single strength multiple breath test (single concentration of methacholine 5mg/ml) 2) Variable dilution technique (five breaths with increasing concentration) 3) Timed tidal breathing technique (administering agent during 2 minute VT breathing)
What are the 4 major types of bronchogenic carcinomas?
1) Squamous cell or epithelial - 1/3 of all lung CA, usually centrally located, most common type in men, frequently causes bronchial obstruction 2) Adenocarcinoma - 1/3 of all lung CA, most common type in women, usually a peripheral lesion 3) Large cell undifferentiated - 10-15%, presents as a large peripheral tumor 4) Small cell - rapidly growing, metastasizes to other sites early, 15-25% of lung CA, oat cell is the most common type
Name 3 characteristics of a constant flow generator.
1) The flow throughout inspiration is constant 2) The flow pattern is not affected by patient effort or lung mechanics 3) The delivered pressure varies with patient effort and lung mechanics 4) Pressure increases linearly throughout inspiration
Name any 3 of the 4 characteristics of a constant pressure generator.
1) The pressure pattern is constant throughout inspiration 2) The pressure pattern is not affected by lung mechanics 3) The flow delivered varies with patient effort and lung mechanics 4) Flow starts out high and progressively decreases throughout inspiration
List any 4 of the 6 pieces of information that should be in a job description.
1) Title 2) General statement of duties 3) Distinguishing characteristics of the job 4) Authority and responsibilities 5) Specific qualifications necessary 6) Criteria by which job holders will be evaluated
According to Egan, for what three reasons might CPAP be applied during T-piece weaning?
1) To prevent deterioration in oxygenation when switching the patient from mechanical ventilation to spontaneous breathing 2) Prevent airway collapse and maintain FRC 3) In patients with COPD to reduce inspiratory WOB secondary to dynamic hyperinflation and auto PEEP
Name any 4 of the 6 key areas that are evaluated by the JCAHO Home Care Accreditation Program.
1) What is the involvement of the patient and family in the process 2) Is there timely access to needed services 3) Is care effectively coordinated 4) Are sound decisions made appropriate to patient's needs 5) Are staff decisions effectively executed 6) Does the organization monitor and evaluate care in an ongoing basis
What are the four mechanisms for transmembrane signaling?
1) lipid soluble drugs cross the membrane (ie: corticosteroids) 2) drug attaches to the extracellular portion of a protein receptor which projects into the cytoplasm (ie: insulin) 3) drug attaches to a surface receptor which regulates the opening of an ion channel (ie: acetylcholine on skeletal muscles) 4) drug attaches to a transmembrane receptor which is coupled to an intracellular enzyme by a G-protein (ei: Beta-adrenergics)
What are the four related components by which the events of mechanical ventilation are most commonly divided?
1) mechanism by which inspiration is initiated 2) nature of the inspiratory phase 3) mechanism by which inspiration is terminated 4) nature of the expiratory phase
List four potentially deleterious actions of Beta2-selective compounds.
1) peripheral vasodilation (decreased afterload) 2) increased heart rate and LVEF 3) increased skeletal muscle tremor 4) decreased serum K+ and increased QT interval 5) increased insulin, free fatty acids, glucose 6) decreased PaO2 (worsened V/Q ratio) 7) myocardial necrosis (proportional to Beta1 component)
What is the chemical name for theophylline?
1,3 dimethylxanthine
If a patient's CES is 0.060 L/cmH2O and total resistance is 20 cmH2O/L/sec., what is the pulmonary time constant?
1.2 seconds (3 time constants are used for exhalation during passive exhalation)
In patients with a normal respiratory system, how much will PCO2 be lowered for every mEq reduction in bicarbonate?
1.2 torr
In contrast to non-intubated patients where small volume nebulizers deposit about 10% of a drug dose in the lungs, intubated patients receive what percent?
1.22 to 3.66%
How many bytes of memory can be stored on a single 3.5 inch floppy disc?
1.44 MB (equivalent to 700 double-spaced pages of typewritten information)
What is the maximum resistance or back-pressure that a spirometer should exhibit?
1.5 cmH2O/L/sec at a 12 L/sec flow
What was the automatic sigh volume on the early models of the PB7200?
1.5 the set tidal volume every 100 breaths
What was the automatic sigh pressure limit on the early models of the PB 7200 ventilator?
1.5 times the pressure limit setting minus ½ the PEEP setting to a maximum of 120 cmH2O
How much of the aerosolized drug delivered by a small volume nebulizer is lost to the mouth and stomach?
1.5% (about 8% with MDI, 66% lost in the delivery apparatus)
Nutritional status is important when weaning patients from ventilatory support. Most patients should receive a caloric intake of what amount based on their resting energy expenditure?
1.5-2.0 x REE (and a protein intake between 1-1.5 g/kg/day)
What is the incidence of cystic fibrosis in blacks?
1/17,000 line births (1/2,000 for Caucasians, about 5% Caucasians are heterozygous. The most common lethal hereditary disease in Caucasians)
How often during blood transfusions does a potentially fatal hemolytic reaction occur?
1/6,000 transfusions
What is the actual cost of the liquid oxygen in cost/pound?
10 cents/lb (least expensive of all factors)
At what value should high system pressure alarms be set?
10 cmH2O > average PIP (VT = 10-15%, VE = 10-15%, low pressure 5-10 cmH2O < average PIP)
What size suction catheter is recommended for 5-16 year old intubated children during CPR?
10 french
How much more common is bronchogenic carcinoma in smokers than non-smokers?
10 times (70 times in heavy and long term smokers)
What is the incidence of difficult intubation as compared to normal when the patient is an insulin-dependent diabetic?
10 times higher (limited joint mobility occurs in 30-40% thought to be due to glycosylation of tissue proteins in patients with chronic hyperglycemia)
What is the range of weight of gas molecules?
10 to the negative 23rd to 10 to the negative 20th g
About one-half of the onset of asthma occurs before what age?
10 years (4-5% of the population of the U.S. has asthma)
When using MDI's, spacers should be standard in children under what year of age?
10 yrs
What percent loss in ideal body weight is associated with increased morbidity and adaptive ability?
10% (another way of saying this is that actual body weight less than 90% of ideal body weight is significant)
Among workers exposed to toluene diisocyanate, what percent develop asthma?
10% (polyurethane, plastics, varnish)
According to Farzan, what percent of asthmatics have an associated sensitivity to aspirin or related drugs?
10-20%
What is the maximum working pressure of the Servo 900B?
100 cmH2O
How many milliliters of abdominal acidic fluid must be present before an abdominal ultrasound will detect it?
100 mL
In line MDI's should not be used in mechanically ventilated infants if the tidal volume is less than what amount?
100 ml
Why is delivery of 100% FIO2 so effective in treating CO poisoning?
100% O2 reduces half life of CO from 5 hrs 20 min to 1hr 20 min
How many 1 micrometer particles would it take to equal the mass of one 10 micrometer particle?
1000 (if the radius increases from 1 to 2, the volume increases from 1 to 8)
A single 10micrometers particle has the same mass as how many 1micrometers size particles?
1000 (or 1,000,000 0.1micrometers size particles)
What is the specific heat of air?
1008 J/kg (water = 4200 J/kg)
How many bytes are there in one kilobyte?
1024 bytes (1 MB = 1024 kB, 1 gigabyte = 1024 MB)
What is the calculation used to determine expected normal PaO2 in the sitting position?
104 - (0.27 x age)
What is the calculation used to determine normal or expected PaO2 in the supine position?
109 - (0.43 x age)
What percent of the gross national product is consumed by health care?
12% (estimated to reach 15% by the year 2000; another author in this text used figures of 15% - 17% by year 2000)
What is the normal PT value?
12-15 seconds
What is the normal range for sodium in a blood chemistry test?
137 to 147 mEq/L
What is the normal range of sodium in a blood chemistry test?
137 to 147 mEq/L
How much more medication is in the standard dose of albuterol delivered by a small volume nebulizer compared with it's MDI counterpart?
14 times more - 2 puffs or .18 mg vs .5 ml or 2.5 mg (two studies suggest MDI:SVN dose ratios of 1:3 & 1:4 to achieve equal bronchodilation)
What percent of the population of the U.S. has no medical insurance?
14% (about 35 million people)
What is the half-life for theophylline in premature infants?
14-58 hours (3.5 to 8 hours in adults, lack of liver enzyme systems up to 1 year)
According to West, retrolental fibroplasia in premature infants can be avoided if the arterial PO2 is kept below what value?
140 mmHg
In 1989, how many years of productive life were lost secondary to COPD?
140,000 (additionally 5% of all physician office visits were due to COPD and 13% of hospital admissions)
The usual MDI dosage of Ipratropium bromide is two inhalations four times a day. What would be the total drug dosage delivered each day?
144 ug (18 ug/puff)
What is the available flowrate range on the PB PR2?
15 - 80 L/min
According to Egan, what is the velocity of liquid spray leaving an MDI?
15 m/s
Cuff to tracheal wall pressures above 60 cmH2O destroy columnar epithelial tissue if sustained over how long?
15 min
At what serum theophylline concentration does the pulse rate increase?
15 ug/ml (electrophysiologic studies showed acceleration of intracardiac conduction at 15 ug/ml and this could be instrumental in provoking supraventricular arrhythmias at higher toxic levels)
Following how many years of abstention from cigarette smoking will the risk of lung cancer approach that of people who never smoked?
15 years
What is the mortality for Legionella pneumonia in hospitalized patients?
15%
When delivering a square wave flow pattern on the Bear2, how much will the flow decrease as the VT is attained?
15%
Oxygen cylinders are filled to 2200 psi. How many kilo-Pascals does this represent?
15,169 kPa (2400 psi = 16,548 kPa)
What is the success rate at one year of people who try to quit smoking?
15-30%
What percent of current and former smokers over the age of 40 will have abnormal spirometry tests?
15-33%
According to Rau, how many drops are there in 1 milliliter of fluid volume?
16 drops (gtt) = 1 ml (physical properties of a particular fluid may vary # of drops in 1 ml; eg: specific gravity, viscosity, size of orifice of dropper)
After oral terbutaline has reached its steady state, what is the mean half-life following drug termination?
17 hours (Albuterol has half-life of only 6.5 hours)
According to P & K, what is the PO2 of blood entering the placenta from the umbilical arteries?
17 mmHg
In patients who are planning on traveling by air, pulmonary laboratory testing with a hypoxic gas mixture may be predictive of need for supplemental oxygen. At what FIO2 is the gas mixture administered?
17%
Very little nutritional support is derived from a 5% dextrose solution. One liter of this solution provides how many kcal of energy?
170 (3.4 kcal/g dextrose)
Expressed as the numbers of persons per 1,000, what is the frequency of persons with a bridge of muscle which crosses from the left or right atrium to the corresponding ventricle and can cause a Wolff-Parkinson-White syndrome?
2 in 1,000
What is the criteria for reproducibility for spirometry?
2 largest FVCs or FEV1s from acceptable maneuvers should not vary by more than 200mL
SIDS occurs with a peak incidence in what age group?
2 mo.
How does Proventil Repetabs work to give 8-12 hr duration?
2mg of the drug is in the coating for immediate release and another 2mg is in the core for release several hours later (Bricanyl depot is a similar Terbutaline preparation available in Europe)
According to the NOTT study, how many years of happy life are "bought" by continuous oxygen therapy?
3 ½
How long after an acute myocardial infarction do creative kinase type MB serum enzyme levels rise?
3-5 hours (peaks at 6 hours and remains elevated for 24-36 hours, >4% indicates MI)
What is the incidence of IPF?
3-5 individuals per 100,000 population
The ductus venosus closes functionally within 24 hours after birth. How long does it take for it to close anatomically and what structure does it become?
3-7 days, ligamentum venosum
What is the name of the chemical, found in urine, which is the molecule to which both COMT and MAO degrade catecholamines?
3-methoxy-4-hydroxymandelic acid
What is the value for the latent heat of fusion for Oxygen?
3.3 cal/gm (water = 80 cal/gm)
Expressed in mL O2 per kg/min, what does one MET equal?
3.5
How many METs of energy expenditure is required in changing bed linens?
3.5 (washing hands & face, brushing teeth, combing hair while seated at sink - 1.5 METs, work simulation - 5 METs)
What internal diameter is the appropriate ETT size for a 2,800 gram infant?
3.5 mm
What are the dimensions of the term neonate's trachea?
3.5-4.0 mm diameter & 4 cm in length
What is the vapor pressure of most MDI's?
300-500 kPa at 20 degrees C (vapor pressure determined by the composition of CFC's, rate of evaporation of CFC's determines coarseness of spray, slower evap. Rate = coarser spray, increased temp. of canisterincreased pressuredecreased particle size)
What is the critical temperature of carbon dioxide?
31.1 degrees Celcius (88.9 degrees F)
What is normal body temperature using the Kelvin scale?
310 K (37 degrees Celcius + 273)
According to Malley, what is the normal mean PaCO2 in young females?
33 mmHg
If the mercury in a mercury barometer were replaced with water, how high would the column need to be?
34 feet (water is 13.6 times less dense than mercury)
Expressed as some number per 100,000 population, what is the estimated prevalence of ventilator-assisted long-term patients in the U.S.?
3:100,000 (in 1983 this represented costs of 1.7 billion or about 1.5% of total hospital costs in the U.S.)
The quality control of spirometry involves volume verification. Explain the technique and size of the syringe.
3L syringe injected and withdrawn at least 3 times at flows of 2-12 L/sec (3L injection times of 1 sec, 6 sec, and between 1 & 6 seconds)
How is NO2 detected by a chemilluminescence analyzer?
3NO2 + Mo (@ 325 degrees Celcius) --> 3NO + MoO3, the sum of NO with and without thermal converter (electrochemical cells have recently been designed and are replacing
The esophageal obturator airway is about 37cm long, contains 16 holes, and has an inflatable balloon at the distal end. What is the size of the 16 holes and the volume of the balloon?
3mm, 30mL
It is estimated that what percent of middle-aged men and what percent of middle-aged women meet maximal criteria for sleep apnea syndrome?
4% middle-aged men, 2% middle-aged women
Which ribs are most likely to be functional during blunt chest trauma?
4-10
Investigators have demonstrated that only 2.7-12.4% of medication placed in a small volume nebulizer is deposited in the lungs. Approximately what percent of the medication nebulized by the Respirgard II nebulizer is deposited in the lungs?
4-5%
What is the goal in grams of nitrogen intake in diet relative to nitrogen excretion to maintain an appropriate nitrogen balance?
4-7 grams/day in intake more than excretion (nitrogen excretion = UUN(urine urea nitrogen) + 4)
According to the "guidelines for cardiopulmonary resuscitation and emergency care" (JAMA), in order to prevent gastric insufflation, the flow of an oxygen-powered resuscitator should be limited to what flow rate?
40 L/min (60 cmH2O)
During mask ventilation in children, how high may the peak inspiratory pressure rise before gastric insufflation occurs when cricoid pressure is applied?
40 cmH2O (38 torr when 40 Newtons applied in adults)
Expressed in mg/kg/hr, what is the clearance rate of theophylline in adult non-smokers?
40 mg/kg/hr (increases 50-75% in tobacco & marijuana smokers and individuals taking phenyltoin(Dilantin); decreases 25-50% with use of cimetidine, ciprofloxin, erythromycin, sustained fever, oral contraceptives, propranol, and allopurinol)
What mean pulmonary artery pressure is the limit that the right ventricle can tolerate acutely?
40 mmHg
What is the maximum weight of the currently available commercial positive pressure ventilators?
40 pounds or 18 kg (factors to consider include: reliability, portability, size, ease of operation, ease of maintenance)
What is the total cross-sectional area of the pulmonary precapillary arterioles?
400 cm2
In order to get the same improvement in PEFR that you get with 5 mg of oral prednisolone, how much budesonide by inhalation is required?
400 ug
How many stops are there on the solenoids of the PB 7200 and what is their operating distance?
4095, 0.0003 inch or 762 Micrometers
One mole of O2 weighs 32g. How much does one mole of CO2 weigh?
44g
What is the maximum number of sighs that can be set on the PB7200?
45 (3 x 15)
What is the tip angle of an oral ETT?
45 degree (nasal/oronasal tubes have 60 degree angle)
What is normal body temperature using the Rankin scale?
558.6 degrees R (98.6 degrees F + 460)
Branson lists several characteristics of an ideal face mask used for ventilation purposes. To prevent rescuer fatigue and improve ventilation of the patient, the valve-filter-extension should have minimal airflow resistance. According to ISO standards, the back pressure produced by the device should be less than what value?
5 cmH2O at a flow of 50 L/min
Nasal breathing filters particles down to what size, according to P & K?
5 micrometers
According to Malley, how much does expected normal PaO2 fall for every 10 years of life?
5 mmHg (begin with 10 y/o & PaO2 of 100 mmHg)
If you draw an arterial blood gas and let it remain at body temperature for one hour before analysis, how much will the PaCO2 increase?
5 mmHg (pH decreases 0.05, PaO2 decreases 150mmHg if initial > 250 and 20mmHg if initial < 150; at room temp., metabolism slowed to 50%; at 0 degress C, metabolism slowed to 10%)
What is the mean survival after diagnosis of Busalfan lung disease?
5 months
What safety limits has OSHA set for exposure to nitrogen dioxide?
5 ppm (as little as 2 ppm exposure has been reported to produce airway reactivity and parenchymal lung injury)
In a modified Allen's test, how long should it take to re-perfuse the blanched hand once the ulnar artery is released?
5 to 10 seconds
The "United States Pharmacopeia" undergoes revision every how many years?
5 years
What percent of adults with asthma will experience severe or fatal exacerbation of asthma after taking aspirin?
5%
What percent of air travelers are under medical care?
5%
What percent of normal populations and OSA populations respectively report a morning headache?
5% and 18% respectively
On a test of forced expiratory volume, how closely must the two largest FVC and FEV1 values agree to be a valid test?
5% or 100 mL, whichever is greater
What is the incidence of bleomycin-induced interstitial disease?
5-10%
What is the potency of fomoterol as compared with albuterol?
5-15 times (MDI with 12ug/puff, FEV1>20% above baseline in patients with stable asthma; oral preparation in Japan)
What size metering chamber is used in most MDI's to control drug delivery?
50 microliters
The O2 concentration of the atmosphere is stable up to what altitude?
50 miles
How frequently does the PB 7200 microprocessor sample airway pressures?
50 times a second
Approximately what percent of patients with a chronic disease fail to take their medications properly?
50%
How much is aerosol delivery reduced by the presence of a humidifier in the ventilator circuit?
50%
What is the 5 year survival rate for patients with IPF?
50%
What is the incidence of clubbing in patients with IPF?
50%
What percent of COPD patients over 50 years of age have some type of heart problem?
50%
What percent of patients have an anatomic structure that can be accommodated by precut fenestrated tracheostomy tubes?
50%
With a 10% loss in blood volume, the immediate drop in the central venous pressure causes how much of a decrease in the discharge rate of the atrial/venous baroreceptors?
50% (with this mild blood loss, there is no drop in arterial pressures)
What percent of patients with childhood onset of asthma are symptom-free 20 years later?
50% or more
How many people in the U.S. are affected with sickle cell disease?
50,000 (results from change in a single base in the DNA coding of the globin chain allowing the formation of Hb)
If you ask a normal adult to insert 3 fingers into his mouth and he can do so, how many millimeters is the mandibular opening?
50-60 mm (if less than 30 mm, oral surgeons consider significant TMJ dysfunction to be present)
How many times greater is the incidence of TB in AIDS patients compared to the general population?
500 times
What percent of the muscarinic receptors in the nasal mucosa are the M3 type?
55% (the rest are M1, no M2 found)
The Dow-Corning tube with ring seals may develop tracheal pressures of what range?
55-100 mmHg
What is the length of the flexible portion of an adult flexible fiberoptic bronchoscope?
55-60 cm
What is a horse-power?
550 foot lbs per second (English measure of power)
According to Branson, particles greater than what diameter do not penetrate to nose?
5micrometers (5-10micrometers - lower respiratory tract with mouth breathing, 1-5micrometers - lung periphery; 80% deposited in upper resp. tract, 10% deposited in lungs, 10% exhaled)
How long should a patient be NPO prior to an elective intubation?
6 hours
90% of the particles produced by ultrasonic nebulizers are in the 1-10micrometers range. What are their MMD?
6 micrometers
What is the minimum time that a forced effort must be made on a volume-time tracing?
6 sec. (with at least 2 sec. Showing an obvious plateau with no volume change; volume of back extrapolation should not be > 5% of FVC or 100 mL, whichever is greater)
According to Rau, how young a child can be expected to learn to use an MDI?
6 years or older (4-6 years if a reservoir device is used)
What is the temperature of the aerosol produced by a Babbington nebulizer?
6-10 degrees F below ambient (a result of the energy lost when high-pressure gas expands)
If you plan a retrograde wire-guided intubation using a fiberoptic endoscope, how long should the wire be in relation to the scope?
6-10 inches longer than the scope (wire goes through suction channel)
What percent of mechanically ventilated patients develop gastrointestinal bleeding?
6-14%
What is Avogadro's number?
6.02 x 1023; the number of atoms, molecules, or ions in one mole
What is the pH of fetal lung fluid?
6.27 (secreted at a rate of 2-3 ml/h/kg of body weight)
What is the pH of the solution in the Sanz electrode?
6.80 (measuring electrode composed of silver/silver chloride, reference electrode composed of mercurous chloride)
According to Ruppel, what is the physiologic range of blood pH encountered in clinical practice?
6.90 to 7.80
What level of chloride in a sweat test is diagnostic for cystic fibrosis?
60 mEq/L
Alpha-1 antitrypsin is used as replacement therapy for homozygous alpha-1-antitrypsin deficiency. What is the dosage for this drug?
60 mg/kg Q week
Assuming sea level and air breathing, what would the PaO2 of a 90 year old be?
60 mmHg (70 mmHg according to PaO2 = 109 - (0.43 x age))
With capillary blood sampling, a PaO2 below what value correlates well with capillary PO2?
60 torr
What percent of the initial flow during a forced vital capacity maneuver is subject to patient effort?
60%
When nebulization is activated on the PB7200, the nebulizer solenoid on the Oxygen side opens if the % set is greater than what value?
60% (the nebulizer solenoid opens on the air side if the % set is 60% or below)
What is the output range of Babington nebulizers in mg/L?
60-70 mg/L (3-5 micrometers MMAD); (USN 1-10 micrometers range, 3micrometers MMAD, output 60-100 mg/L)
Name 2 unique features of the Circulaire nebulizer, not found on standard small volume jet nebulizers.
A distensible reservoir bag, a one-way valve placed between the neb. And the patient (serves as a baffle), an open side port with adjustable inspiratory retard to allow additional air if the patient inhales beyond the combined volume of the reservoir and the nebulizer output
What is the distinct LDH pattern with MI?
A distinct isoenzyme pattern LDH1 > LDH2
What do you call any chemical that alters an organism's functions or processes?
A drug
What is an antisialogogue?
A drug administered to dry up airway secretions
According to Egan, what does an adrenergic drug do?
A drug that stimulates a receptor responsing to norepinephrine or epinephrine
What is the Jinotti Oxygen insufflation catheter?
A dual-lumen suction catheter that can be used to suction secretions and deliver Oxygen between suction procedures
What is an exudate?
A fluid with a high protein content that has exuded from capillaries as a result of abnormal vessel "leakness" as with inflammation
What is the 2-hour post-prandial glucose level?
A glucose level drawn after a meal
What is the rationale for determination of a 24 hour urine urea nitrogen level?
A good indicator of lean body mass breakdown (nitrogen excretion = 24 hours UUN + 4; divide grams of protein in diet by 6.25 to get number of grams of nitrogen intake)
With regard to V/Q ratio, what does a lower than normal Phase III CO2 suggest?
A high V/Q ratio
What is "hemoglobin Köln"?
A high affinity mutant in which erythrocytosis does not develop because of hemolysis
What is the meaning of the term ischemia?
A local deficiency of blood supply due to a vascular disorder
Vitalograph developed the Aerosol Inhalation Monitor (AIM) to help teach patients the closed-mouth MDI administration technique. Proper sequence and timing when using the monitor results in what?
A merry tune
What is the immediate consequence of sodium bicarbonate therapy?
A paradoxic intracellular acidosis & rise in cerebrospinal fluid PCO2 because CO2 is more permeable through cell membranes and the blood-brain barrier than bicarbonate ions
Define "limit variable" according to Chatburn's classification system.
A parameter that can reach and maintain a preset level before inspiration ends, but does not terminate inspiration (either pressure, flow, or volume can serve as a limit variable; ex. Pressure as limit variable - PSV, PCV)
What is the relationship between air temperature and water vapor capacity?
A positive relationship (as temp increases, water vapor capacity increases)
What is a mole?
A quantity of a substance in grams corresponding to atomic weight (atoms), molecular weight (molecules), or formula weight (ions of nonmolecular compounds) 6.02 x 1023 particles
What is a gram molecular weight (gmw)?
A quantity of a substance in grams equal to its molecular weight.
What is tachyphylaxis?
A rapid decrease in response to a drug
What is specific heat?
A ratio of heat capacity of a substance compared to that of a standard (water)
What causes a secondary increase in cell counts?
A result of stimulation of the bone marrow secondary to other diseases or disorders
What is the most important piece of accessory equipment needed in the home of a ventilator-assisted patient?
A self-inflating manual resuscitator and mask (a second back-up ventilator is necessary for a patient who has 20 hours or more on a ventilator or who lives in a rural area)
What is the Ballard score?
A simplified score for assessment of fetal maturation of newborns. (six neuromuscular signs, six physical signs)
What is a pascal?
A unit of pressure equal to a force of 1 Newton acting over 1 square meter
Generally, what 3 modes of ventilation are used in the home?
A/C, SIMV, pressure-limited ventilation
Q: In a healthy adult, what maximal intrapleural pressure may be generated during forced exhalation?
A: +70 cmH2O (51.47 mmHg)
Q: In a healthy adult, what maximal negative intrapleural pressure may be generated during forced inspiration against a closed glottis?
A: -50 cmH2O (-36.8 mmHg)
Q: Before the beginning of inspiration at FRC, what are the alveolar and pleural pressure respectively?
A: 0 and -5 cmH2O
Q: Name 5 potential mechanisms for accumulation of pleural fluid.
A: 1) Increased hydrostatic pressure in microvascular circulation 2) Decreased osmotic pressure in microvascular 3) Decreased pressure in pleural space (total lung collapse) 4) Increased microvascular permeability 5) Impaired lymphatic drainage 6) Movement of fluid from peritoneal space
Q: How long does it usually take a reticulocyte to mature into an erythrocyte?
A: 1-2 days
Q: What is the maximal peak flow that can be achieved through nasal breathing?
A: 1.5 to 2 L/s
Q: according to P & K, what PaO2 is required for 100% saturation?
A: 150 mmHg
Q: How much water do the kidneys excrete each day and how much Na+ does it contain?
A: 1500 mL, 50 mEq Na+ (40 mEq K+, 90 mEq Cl-)
Q: The trachea is supported by how many C-shaped cartilages?
A: 16 to 20
Q: according to P & K, the adult normal respiratory rate ranges from 10-20 BPM and averages 16 BPM in men. What is the average respiratory rate for women?
A: 18
Q: How is the predicted maximum heart rate determined?
A: 220 BPM - age
Q: What is the height and weight of normal lungs at end exhalation?
A: 24 cm, 900-1000 g
according to Egan, gas delivered to the hypopharynx, such as when administered by a nasal catheter, should be delivered at what temp. and relative humidity?
A: 29-32 degrees C at 95% RH (AH 28-34 mg/L; dry gas to the nose or mouth 22 degrees ->50% RH, dry gas to the trachea 32-35 degrees C ->100% RH
Q: In mL O2/kg body weight/min, what is the normal resting O2 consumption?
A: 3 - 3.5
Q: Innervation of the diaphragm in the dog is where?
A: 4th to 6th cervical nerves
Q: There is only a small ventilatory response to low arterial blood PO2 until it falls below what level?
A: 50 torr
Q: In mEq/L, what is the total buffer base in the body?
A: 54 2 mEq/L (48 mEq/L according to Burton, may be for blood only)
Q: Given an FIO2 = 0.21, a PCO2 = 40 and normal temp at sea level, what is the calculated value for PAN2?
A: 573 torr
Q: What is the estimate of the total number of alveolar macrophages in the lungs?
A: 600 million (increases in cigarette smokers as much as four times; originate from circulating monocytes plus some that originate from resident cell division)
Q: What is the half life of transferrin?
A: 8-10 days (a carrier protein for iron - it is a more useful indicator of visceral protein stores than albumin in patients with liver disease; normal 200-400 mg/dL)
Q: The lymphatics are responsible for what percent of pleural fluid absorption?
A: 90% ( the remainder is absorbed via convection across the pleural mesothelium into the lung and chest wall)
Q: What proportion of the total mechanical work for one breath is attributable to elastic forces in a normal individual?
A: About 2/3
Q: Name the two branches of the left coronary artery.
A: Anterior interventricular, circumflex
Q: What term is used to define the effect of CO2 or H+ on the uptake and release of O2 from Hb?
A: Bohr effect
Q: What usually happens to ventilation as a result of regional reduction or cessation of pulmonary blood flow?
A: Decreased ventilation to the corresponding region
Q: Define "transrespiratory" pressure.
A: Difference between atmospheric pressure and alveolar pressure. (transpulmonary pressure = Palv - Ppl, transthoracic pressure = Ppl - Pbs where bs = body surface)
Q: What segment of the population normally tends to use costal breathing rather than diaphragmatic?
A: Females
Q: What phenomenon is responsible for ventilatory limitation that occurs when exercising to the level that the ventilation required is greater than the maximum sustained ventilatory capacity (MSVC)?
A: Ventilatory muscle fatigue
What does hydrophilic mean?
Ability to absorb water
Normal RAW accounts for about how much of the total WOB?
About 1/3
What is the time interval that elapses between the administration and the onset of action of succinylcholine?
About 30 seconds
What term should we use to describe the change on velocity of an object per unit time?
Acceleration
State Newton's second law of motion.
Acceleration of an object is directly proportional to the force exerted,and inversely proportional to its mass. Accel. = Force/mass
Upon completion of the JAHCO survey for accreditation of home care organizations, what are the four categories that JAHCO may award?
Accreditation with commendation, accreditation, conditional accreditation, not accredited
According to Egan, what are the primary indications for humidifying inspired gas?
Administration of medical gases, delivery of gas to the bypassed airway, thick secretions in non-intubated patients (also: hypothermia, reactive airway response to cold inspired air)
How quickly does oxygenation decrease with suctioning?
After 5 sec. (total time should not exceed 10-15 sec)
If a closed-circuit He FRC determination must be repeated, how long should you wait between tests?
Al least 4 minutes
What term is used to describe a patient's inability to label affective states verbally?
Alexithymia
What is Churg-Strauss syndrome?
Allergic granulomatosis - a form of vasculitis characterized by asthma, blood eosinophilia, or extravascular necrotizing granulomas
What does large numbers of eosinophils in the sputum indicate?
Allergic response (may be asthma)
What is eosinophilia or eosinophilic leukocytosis most characteristic of?
Allergic states and parasitic infestations
In what 3 forms does Aspergillus fumigatus occur?
Allergic, invasive, fungus ball
What is the function of the rise time or pressure slope control?
Allows adjustment of the initial flow delivered during pressure support breaths (Servo300, Bear1000)
Give the 2 reasons why the closed circuit rebreathing technique is the preferred method for spirometry?
Allows tight seal with mouthpiece, evaluation of volume inspired
Name a drug, other than Provera, that can be used in COPD patients as a respiratory stimulant.
Almitrine bimesylate, Methylphenidate(Ritalin)
Other than progesterone and doxapram, name two other drugs used as respiratory stimulants.Other than progesterone and doxapram, name two other drugs used as respiratory stimulants.
Almitrine bismesylate, Protriptyline, Theophylline, Acetazolamide, Naloxone
According to Farzan, what are the 5 causes of hypoxemia?
Alveolar hypoventilation, impairment of diffusion, V/Q mismatch, RL shunt, reduced O2 in mixed venous blood (extrapulmonary factors - CO, metabolic rate, increased extraction)
What term means the same as intrapulmonary pressure?
Alveolar pressure
Alkaloid muscarine, which stimulates acetylcholine receptor sites is derived from what plant?
Amanita muscarita
What is the ASDA?
American Sleep Disorders Association (the ASDA Polysomnography (PSG) Task Force published indications for polysomnography since 1994)
Standardization of the design of tracheal tubes is overseen by what organization?
American Society for Testing and Materials (ASTM), F-29 subcommittee (former direction came from the ANSI Z-79)
What eastern mediterranean plant is the source of khellin, the prototype of chromolyn sodium?
Ammi visnaga
What is the drug of choice for disseminated histoplasmosis?
Amphotericin B
What enzymes are used primarily in assessing pancreatitis?
Amylase and lipase
In terms that apply to unions, describe an agency shop.
An agreement with a union where the union represents all workers and everyone pays union dues but there is no necessity to join the union to work (eliminates "free riders")
In terms of the relative numbers of protons and electrons, what is a cation?
An atom which has an excess number of protons
What is idiopathic thrombocytopenia purpura (ITP)?
An autoimmune disorder in which antibodies are produced that destroy the person's own platelets
What is the proper name for an apparatus that consists of two electrodes placed in an electrolyte solution?
An electrochemical cell
Explain what a good "start of test" includes.
An extrapolated volume of less than or equal to 5% of the FVC or 150 mL, whichever is greater; no hesitation or false start; a rapid start to rise time
What is the Moody Friction Factor?
An index of the roughness of the internal lumen of a tracheal tube (secretions will increase this factor)
What is a hygrometer?
An instrument used to directly measure relative humidity
What causes primary polycythemia?
An uncontrolled proliferation of hematopoietic cells within the bone marrow
Name 3 of the most commonly causative organisms of an empyema.
Anaerobic bacteria, pneumococcus, staphylococcus, streptococcus, certain gram negative bacteria
Anaerobic bacteria can cause what three types of lung infections and how are they distinguished radiographically?
Anaerobic pneumonia - has cavity 2 cm, anaerobic necrotizing pneumonia - has several small areas of cavitation, lung abscess - infiltrate with cavitation
What is the cause of pernicious anemia?
Anemia that develops as a result of the stomach not producing enough intrinsic factor which enables the absorption of vitamin B12 (extrinsic factor)
Name conditions associated with increased 2,3 DPG.
Anemia, hyperthyroidism, hypoxemia associated with COPD, congenital heart disease, ascent to high altitude, decreased CO - heart failure, normal subjects after strenuous exercise
What is the complication rate of endotracheal intubation performed by anesthesiologists compared to emergency room physicians?
Anesthesiologists have 1/3 the complication rate as ER physicians
What type of ETT contains a steel reinforcing wire that is wound spirally within the wall of the tube?
Anode tube (has two rectangular marks 1 & 2 cm above cuff on small tubes (<6.5) and 2 & 4 cm marks above the cuff >6.0 tubes to reference location of ETT tip)
What term refers to a drug or chemical that is able to bind to a receptor but causes no response?
Antagonist
What are the two forms of coal mining and which has the higher incidence of coal miners pneumoconiosis?
Anthracite and Bituminous with anthracite having the higher incidence
What are the 5 types of medications that are aerosolized to the lung parenchyma?
Antibiotics, antivirals, antifungals, surfactant, enzymes
What segments of the lung are most commonly involved in reactivation tuberculosis?
Apical and posterior segments of upper lobes
What is the diameter of an oxygen atom?
Approximately 1 angstrom
In the normally developing newborn, when does the foramen ovale permanently close?
Approximately 3 months
Name 3 inert gases which can be used for gas dilution.
Argon, neon, helium
What is the 5-year survival percent for lung cancer patients?
Around 10%
In infant ABG sample can be obtained from a peripheral arterial line. Name two other means for collecting and infant's arterial blood?
Arterial puncture, umbilical artery catheter (Egan also says heel stick - capillary sampling)
SRS-A is deactivated by what enzyme?
Arylsulfatase
Early studies demonstrate that inappropriately applied PPV can actually increase WOB while causing alveolar ventilation. By how much may inappropriately applied PPV increase WOB?
As much as 250%
What 3 ways may infectious agents spread to the lungs?
Aspiration, inhalation, via blood to lung (blood born) from distant infected site
Trends in capnography can estimate physiologic deadspace and detect esophageal intubation. Name one other use to which capnography can be helpful.
Assess blood flow during cardiac arrest, determine appropriate PEEP levels
When does the LP6 Plus switch to a backup mode of operation?
At a set rate below 6 BPM if the patient fails to initiate an assist signal within 20 sec. - an alarm (apnea) is activated and the vent delivers 10 BPM
For the MVV, what should the period of time be and how should the data be reported?
At least 12 seconds, no greater than 15 sec; reported in L/min at BTPS
If an open-circuit nitrogen washout test of FRC must be repeated, how long should you wait between tests?
At least 15 minutes
If an accurate estimation of REE is necessary, how long should the rest period before indirect calorimetry be?
At least 2 hours (REE = [3.9(VO2) + 1.1(VCO2)] x 1.44)
How far must a patient be able to open his mouth to allow a #3 Macintosh blade to fit into the mouth?
At least 20 mm (if less than 20 mm, it is unlikely that the larynx will be visible by conventional laryngoscopy)
According to Branson, the volume delivered by IPPB should exceed the patient's spontaneous tidal volume by what amount?
At least 25%
When using biologic controls as a way of assessing accuracy and precision of a spirometer, how many subjects and how many repeats should be measured?
At least 3 subjects with 5-10 measurements of each reported measurement
In order for a ventilator to function as a true flow generator, how much greater should the driving pressure be than the airway pressure?
At least 3 times
Heated humidifiers should operate within what temperature and humidity range?
At least 30 mg/L at 30 degrees C
For diagnostic functions, the recorder attached to a spirometer must have what level of sensitivity?
At least 5 mm/L for volume and a time base of 1 cm/sec (for manual measurements, at least 10 mm/L and 2 cm/sec)
Why do diffusion abnormalities not usually affect oxygenation?
Because with a normal cardiac output, the Hb is fully saturated with O2 in about 1/3 the time a RBC is exposed to available O2 in the capillary. Even with severe diffusion abnormalities, there is usually enough time for Hb to become fully saturated with O2.
Name three glucocorticoids given by the inhalation route and their respective dosages.
Beclomethasone (Beclovent, Vanceril) - 0.042 mg, Flunisolide (Aerobid) - 0.25 mg, Triamcinolone (Azmacort) - 0.10 mg
What three different types of inhaled corticosteroid preparations are currently available in the US?
Beclomethasone (Beclovent, Vanceril), triamcinolone (Azmacort), flunisolide (Aerobid)
Name 4 situations, according to P & K, that sighs are indicated.
Before and after suctioning and bronchoscopy, during CPT, before and during extubation, if small tidal volumes are used with normal or increased compliance during controlled ventilation, during re-expansion of lung collapse
What are the three classes of parasympatholytic drugs?
Belladonna alkaloids, synthetic compounds, semisynthetics
What is the brand name for Fenoterol?
Berotec
What is the name of the cellular metabolic process by which fatty acids are converted into acetyl Co A?
Beta oxidation
Consumption of foods high in antioxidants may have a role in preventing COPD. Name any three of the antioxidants listed by Hodgkin.
Beta-carotene, vitamin C, vitamin E, Selenium, glutathione
Name any three receptors whose activation results in airway smooth muscle relaxation.
Beta2-adrenoceptor, Adenosine(A2), Prostaglandin E2 & I2, histamine (H2), VIP(vasoactive intestinal peptide), PHM(peptide histidine methionine)
In a single-breath DLCO test, how long should the breath-hold be?
Between 9 and 11 seconds (as close to 10 seconds as possible)
According to Finucane and Santora, at what age should an individual be considered a child?
Between the ages of 1 and 8 years (>16 is adult, <1 year is infant, no category for age 8-16years)
What is the most common age at which foreign body aspiration occurs?
Between the ages of one and three years
According to P & K, what are the four primary body buffer systems?
Bicarb/carbonic acid (50-60% buffering), dibasic/monobasic phosphate, ammonia/ammonium ion, hemoglobin/Hb ion, serum protein/protein ion
What is the most common subnumerary anomaly of the lungs?
Bilobation of the right side
What three important advances in the last 10 years have resulted in a decrease in mortality from HMD?
Biochemical tests for pre-natal detection of babies at risk, pharmacologic means of accelerating maturation of lung surfactant-producing system, development of mechanical means of maintaining gas exchange
Name 3 commercially available airway pressure monitors.
Biomed M-10, Bunnell, Nova-Metrix, Sechrist 1705, Sechrist 400, Sechrist 600
What are the differences between the Bird Mark 9 and the Mark 8?
Bird Mark 9 has a larger pressure magnet, aneroid pressure gauge calibrated from -30 to 200 mmHg, and the replacement of the air/mix control with a dual flow range control (when "in" only a single venturi is operational and peak flow = 200 L/min. When"out" two venturis are activated and peak flow = 270 L/min) (Bird Mark 8 = Mark 7 + NEEP)
Name any four contraindications for nasotracheal intubation.
Bleeding disturbances, nasal pathology (epistaxis, polyps, septal deviation, infections), Basal skull fracture, CSF leakage, Chronic sinusitis, Nasal stenosis
What are the 4 basic screening tests to evaluate hemostasis?
Bleeding time, platelet count, APTT, and PT
Name 4 potential problems in using nasopharyngeal airways.
Bleeding, infection (otitis media, sinusitis), obstruction by blood or mucus, and laryngospasm
Name 4 of the 10 drugs listed by P & K that are associated with chronic interstitial disease.
Bleomycin, Basulfan, Chorambucil, Cyclophosphamide, Melphalan, Methotrexate, Mitomycin, Nitrofurantoin, Nitrosoureas, Penicillamine
What typically causes iron deficiency?
Blood loss
What are 3 causes of anemia?
Blood loss, increased destruction of RBCs, decreased production of RBCs
According to Egan, what are five primary therapeutic indications for fiber-optic bronchoscopy?
Brachytherapy (direct application of radiation therapy), Facilitation of endotracheal intubation, Removal of airway secretions, Removal of aspirated foreign bodies, Therapeutic bronchial lavage, Palliative therapy of malignant tumors causing obstruction, Laser phototherapy, Fulguration using heater probes or bipolar electrodes
Name any four substances that induce endothelium to produce and release nitric oxide.
Bradykinin, Serotonin, ATP, Acetylcholine, Thrombin, Substance P, Nitroglycerine, Nitroprusside
What 3 ways does bronchoscopy retrieve tissue specimens?
Bronchial brush, forceps, needle
What are the effects of histamine on the airway walls and vascular walls respectively?
Bronchoconstriction and Vasodilation (mast cells release histamine)
What are the two contraindications to bland aerosol administration?
Bronchoconstriction, history of airway hyperresponsiveness
Name any three useful actions of theophylline in humans.
Bronchodilation, respiratory center stimulant, increase diaphragmatic contractility, decreased pulmonary artery pressure, increased CO(increased inotropy, increased rate, decreased SVR), anti-inflammatory effects, excretion of salt and water
What are the two desired effects when sympathomimetic bronchodilators are given?
Bronchodilation, secretion clearance
In the U.S., what is the most common malignancy?
Bronchogenic carcinoma (25% of all Americans dying from cancer. Most common cancer of women since 1986)
According to Egan, why do some asthmatics have an increased airway resistance when breathing cold air?
Bronchospasm due to a shift of the isothermal saturation boundary to move distal airways with associated stimulation of mast cells in that area
What mechanisms are responsible for the deposition of particles less than 3micrometers in diameter into the lung parenchyma?
Brownian movement, diffusion
Name 4 types of humidification systems currently available as described by P & K.
Bubble/diffusion jet, large volume bubble, large volume wick, large volume passover, large volume temp. servo controller, spinning disk, HME
What is the safest instrument for suctioning the infants airway?
Bulb syringe
Archimedes principle is otherwise know by what term?
Buoyancy
How have the molecules that have a longer duration of action been modified from the original isoproterenol molecule?
By altering the catechol nucleus to prevent COMT degradation
How have the molecules that have Beta2 specificity been modified from the original isoproterenol molecule?
By altering the side chain
In what 3 ways can CO poisoning be harmful to cellular oxygenation?
By combining with Hb, left shift of O2Hb dissociation curve, direct metabolic effects of dissolved CO in plasma
How is the ventilatory reserve calculated?
By comparing the peak exercise ventilation to the MVV obtained during PFTs (50-80% in normal subjects)
According to Egan, all modes of ventilatory support facilitate living expansion. How?
By increasing the transpulmonary pressure gradient
Nocturia is often associated with what heart condition?
CHF (chronic heart failure)
What occurs when the electrical activity of the heart continues but the mechanical pump does not function?
Electromechanical dissociation
What is the mechanism of action of class IV antiarrhythmic agents?
Calcium channel blockers (slow conduction velocity in A-V node, ex: verapamil, diltiazem, adenosine)
What is the important distinction between calibration and quality control?
Calibration may or may not be needed, QA must be applied on a routine basis
What is another name for the mercury-mercurous chloride reference electrode in a pH electrode?
Calomel electrode
According to the ATS standards, what capacity and flowrate capability should a diagnostic spirometer have that is used to measure VC and FEV1?
Capacity of at least 7L, able to measure flowrates between 0-12 L/sec with 95% accuracy
What class of organic chemicals is described as polyhydroxylated molecules with at least three carbons, one of which is a ketone or an aldehyde?
Carbohydrates
What is the most commonly tested oncofetal antigen?
Carcinoembryonic antigen (CEA)
There are four major mechanisms by which patients with chronic lung disease are limited in their ability to engage in physical activity. Name 3.
Cardiovascular limitations, ventilatory limitations, gas exchange limitations, psychological limitations
What happens in Cushing's disease and hyperaldosteronism with soidum?
Cause kidneys to retain sodium
What type of immune response involves the participation of macrophages that recognize a specific foreign antigen and of T-helper lymphocytes, which produce proteins that activate macrophages to eliminate the original antigen?
Cellular
What were the 5 key components of early modern computers?
Central control unit, arithmetic logic unit (ALU), input mechanism, memory, output mechanism
Name two configurations of water-sealed bell spirometers.
Chain compensated spirometer, stead-wells spirometer (for rapid breathing tests)
What are 3 types of adapters available that allow an MDI to be placed into a ventilator circuit?
Chamber (reservoir, spacer), in-line devices, elbow devices
Name the 3 basic styles of adapters available for use in delivering MDI's to ventilated patients.
Elbow - MDI is actuated directly into the airway, Inline - MDI is actuated into the inspiratory limb, Chamber devices
In laminar flow, the formula which describes the pressure difference required to produce a given flow is Chang in P = (Viscocity8lV)/(Pir4). What is the corresponding formula for turbulent flow?
Change in P = (flV2)/(42r5); f = frictional factor (incorporates viscosity, density, and roughness of tube wall - Moody Friction Factor)
According to West, what is the probable explanation for the observation that age or emphysema increases the compliance of the lung?
Changes in the elastic tissue (fibers of collagen or elastin)
What is the meaning of the term miliary?
Characterized by tiny lesions resembling millet seeds
Whose gas law explains why 500 ml of gas inhaled at 25C will expand to 520 ml when warmed to body temperature?
Charles' law
Whose gas law states that for a given mass of gas, the volume varies directly with the absolute temperature when the pressure is held constant?
Charles' law
Whose law is described as "if pressure and mass remain constant, volume varies directly with changes in absolute temperature"?
Charles' law
What are the five names by which a drug may be known?
Chemical name, code name, generic name, official name, trade name
What is the traditional method used for nitric oxide and nitrogen dioxide concentration analysis?
Chemiluminesence (NO reacts with O3 ---> NO2* + O2, NO2* changes back to ground state by emitting electromagnetic radiation)
What structure is most common cause of chest pain?
Chest wall
The Infrasonics Star Synch unit allows triggering of the Infant Star by what method?
Chest wall movement
In reference to tents, what is the meaning of the acronym CAM?
Child Adult Mist (Mistogen)
The majority of the spray (60-80% by weight) from most MDI's consist of what ingredient?
Chloroflourocarbons (the active drug 1%)
On what chromosome does the genetic defect in myotonic dystrophy occur?
Chromosome 19
What five major pulmonary conditions are conventionally included in the classification of COPD?
Chronic bronchitis, emphysema, asthma, bronchiectasis, & CF
What is a fibrothorax?
Chronic formation of fibrous tissue and adhesion of the two pleural layers
What are the 5 symptoms of patients at risk for sleep apnea?
Chronic loud snoring, gasping or choking episodes during sleep, excessive daytime sleepiness (especially drowsy driving), automobile or work-related accidents due to fatigue, personality changes or cognitive difficulties related to fatigue
What term denotes the presence of chyle in the pleural cavity?
Chylothorax
What Ck isoenzyme occurs in skeletal muscle?
Ck-MM
What is the name commonly given to the blood gas electrode composed of platinum covered with a thin polypropylene membrane?
Clark (or polarographic) electrode
In moderately or severely obstructed patients, what is the relationship between FRC determined by closed-circuit and plethysmographic methods?
Closed-circuit typically less than body plethysmography results (closed-circuit usually larger than single-breath FRC)
Which gas law provides the quantitative relationship which allows for the conversion of ATPS to BTPS?
Combined or universal gas law
What technique is used to produce therapeutic aerosols?
Comminution - shattering of a solid or liquid into small particles (3 methods of comminution - jet mixing, babbington, ultrasonic)
Name 3 pieces of information provided by pressure-volume loops.
Compliance, trigger sensitivity, overdistention, WOB (flow-volume loops RAW, exp. flow, response to bronchodilator treatment)
What is the major determinant of the vapor pressure in a MDI?
Composition of the chloroflourocarbon
What type of USN transducer produces the highest output?
Concave (disadvantage - requires a constant level of solution)
What three factors determine how long nitric oxide will remain unconverted to nitrogen dioxide in an oxygen-containing environment?
Concentration of NO, Oxygen concentration, time
Name 4 side effects that have been reported by health care workers administering ribavirin and pentamadine.
Conjunctivitis, headaches, bronchospasm, shortness of breath, and rashes
A group from Ohio state published a classic study dealing with leadership. What are the two parameters that they examined?
Consideration, initiating structure
A ventilator that maintains constant pressure in the patient breathing circuit throughout inspiration, regardless of lung-thorax changes describes what type of ventilator?
Constant pressure
What modes of ventilation are available on the Life Products LP6 Plus?
Control, A/C pressure limited, SIMV
What modes of ventilation are capable of providing full ventilatory support?
Control, A/C, IMV, SIMV, MMV, IPSmax, PC-IRV, APRV (partial - IMV. SIMV, IPS, MMV, APRV)
Who first reported the effects of positive pressure ventilation on cardiac function?
Cournard (1948)
What is another name for the lower portion of the septum secundum?
Crista dividens (located within the intra-atrial septum)
What do you call the pressure required to keep an equilibrium between the liquid and gas phases of a substance at its critical temperature?
Critical Pressure
What do you call the critical temperature combined with the critical pressure of any substance?
Critical point (He - 267.9 degrees Celcius at 2.3 atm; O2 - 118.8 degrees Celcius at 49.7 atm; CO2 - 31.1 degrees Celcius at 73 atm)
What do you call the temperature above which no liquid can exist in its liquid form, no matter what pressure is present?
Critical temperature
What two drugs are currently available as dry-powder inhalers in the U.S.?
Cromolyn sodium (Intal) - spinhaler, albuterol(Ventolin Rotacaps) - rotohaler
As stated in Egan, name three multivariate indices used in predicting weaning success.
Crop index; adverse factor/ventilation scores (hemodynamics, neuro status, nutrition, infection, & ventilation, >55 = predicted failure 97%); weaning index (WI = PTI x (VE40/VTSB))
In the lung, what factor most affects diffusion?
Cross sectional area (secretions, bronchospasm, mucosal edema, decreased cross-sectional area slow diffusion)
Name the fungus that exists as a yeast and resides in the soil, predominantly in the droppings of pigeons.
Cryptococcus neoformans
What is the most frequent cause of fungal infection in patients with advanced HIV disease?
Cryptococcus neoformans
Torulosis is a fungus acquired via contact with bird excreta. By what other name is this fungus known?
Cryptococcus neofornans
What word literally means "split" by electricity?
Electrolysis
In addition to CLIA88, HHS sets standards for reimbursement under the DRG system for Medicare patients and reimbursement requires that changes for procedures be correctly classified by CPT codes. What does CPT stand for?
Current Procedural Terminology (CLIA - Clinical Laboratory Improvement Amendments, HHS - Health & Human Services, DRG - Diagnosis Related Groups; SSA - Social Security Administration sets limits for disability)
What is the pharmacological treatment of sleep apnea?
Currently there are no safe and effective medications indicated in the treatment of sleep apnea
What term denotes bluish discoloration of skin and mucus membranes due to desaturated Hb in capillary blood?
Cyanosis
What two enzyme pathways can metabolize arachidonic acid?
Cyclooxygenase and Lipoxygenase
Name three medical gases that are maintained in their liquid states inside cylinders at room temperature.
Cyclopropane, nitrous oxide, carbon dioxide
What disease is characterized by dysfunction of exocrine glands, chronic pulmonary disease, pancreatic insufficiency, and high electrolyte concentration in sweat?
Cystic fibrosis (mucoviscidosis)
Name the three prevalent herpes viruses that infect the lungs of AIDS patients.
Cytomegalovirus, herpes-simplex, varicella-zoster
In addition to T-4 and T-8, there are two other T-lymphocytes. What are they called?
Cytotoxic T-cells, Natural-killer T-cells
What PFT abnormality is used as a marker for bleomycin-induced lung injury?
DLCO - a fall of 20% or more from baseline
What is meant by the term "Krogh's constant"?
DLCO/VA - the alveolar volume at which the DLCO was measured
What agent is given as treatment for malignant hyperthermia and at what dosage?
Dantrolene (a muscle relaxant), 2.5 mg/kg followed by additional doses of up to 10 mg/kg prn, other management includes hyperventilation and volume resuscitation (untreated mortality 75-100%, treated 5-10%)
Other than snoring, what is the main symptom of sleep apneas?
Daytime hypersomnolence
What is meant by the term "secondary drowning"?
Death from delayed complications following apparent recovery of near drowning (5,000 individuals in the U. S., mostly young, die each year from drowning)
With regard to beta-adrenergic bronchodilators, what is the mechanism and time course of the development of tolerance?
Decrease in density of beta receptors on cell surface; within two weeks of therapy (full recovery will return in about two weeks after cessation of drug)
What is the effect on temperature when a gas is rapidly decompressed?
Decrease in temperature (cooling of expansion)
Name any two of the three mechanisms by which the ductus arteriosus closes at birth?
Decrease of blood flow through the ductus, constriction due to higher PaO2, removal of maternal prostaglandins
What two possible explanations have been proposed to explain why discontinuation of nitric oxide therapy results in rebound hypoxemia and pulmonary hypertension?
Decreased NOS activity, increased cGMP-phosphodiesterase activity
Describe the effects of decreased compliance and increased airway resistance, respectively on a constant pressure generator.
Decreased compliance = more rapid filling of alveoli, more rapid tapering of flow, and a shortened inspiratory time; Increased resistance = slower flow into lungs, slowing the taper of the flow waveform, and a lengthening of the inspiratory time
According to Egan, what are primary indications for aerosol administration?
Delivery of medication to the airway, sputum inductions
An intramyocardial PCO2 in excess of 475 torr contributes to what cardiac abnormality?
Electromechanical dissociation
According to P & K, what are the 4 goals of aerosol therapy?
Delivery of medications, Improve bronchial hygiene (improve cough, hydrate retained secretions, restore & maintain normal mucocilliary escalator), Condition inspired gas, Sputum inductions
What is the name of the 5-carbon sugar found in DNA?
Deoxyribose (Ribose in RNA)
Which governmental department and under what act do coal miners receive compensation for "black lung"?
Department of labor, Black Lung Benefits Reform Act of 1977 (examining physician should follow procedures outlined in the Federal Register)
With a floating-island nebulizer, what regulates particle size and affects total aerosol output?
Depth of the jet below the surface of water
It has been estimated that the incidence of difficult intubation is about 10x higher in what disease than in normal healthy patient and why?
Diabetes Mellitus - limited joint mobility syndrome occurs in 30-40% of insulin-dependent diabetes, thought due to glycosylation of tissue proteins in patients with chronic hyperglycemia
What 2 diseases is hyperglycemia seen in?
Diabetes, Cushing's disease (treated with steroids and hormones)
What is the generic name of the most common MDI propellant, propellant 12?
Dichlorodiflouromethane (trichloroflouromethane = propellant 11, dichlorotetraflouromethane = propellant 114, these are mixed with 12 to produce the desired vapor pressure)
What portion of the CBC is traditionally performed by examination of a blood smear by a technologist?
Differential
What is the major disadvantage of the Rae tube?
Difficult to suction
What is orthopnea?
Difficulty breathing while lying down
Name any four types of drug information that can be available on package inserts.
Dosage strength, dosage frequency, adverse effects, shelf life, and storage requirements
Name any three types of computer printers.
Dot matrix, thermal, ink jet, laser
According to Egan, what is the only current ventilator to use true volume triggering?
Drager Babylog
What are the three main components of drug-receptor signaling with G-protein linked receptors?
Drug receptor, G-protein, the effector
What are the 5 major components of a MDI?
Drug, propellant/excipient mixture, canister, metering valve, mouthpiece/actuator
With what neuromuscular disease is the "Gower maneuver" associated?
Duchenne Muscular Dystrophy (Gower maneuver - individual has trouble getting up from floor, walks hands up thigh until he has pushed himself upright. X-linked, so only seen in males)
During fetal life, umbilical venous blood enters the inferior vena cava via what structure?
Ductus venosus
In Europe, fenoterol is compounded with ipratropium. What is the trade name for this combination?
Duovent (fenoterol - Berotec - MDI 0.2mg/puff, a resorcinol)
What is the most common symptom of PTE?
Dyspnea
What is the most important principle in the non-surgical treatment of bronchiectasis?
Effective removal and reduction of bronchial secretions
What is the mechanism of action of class II antiarrhythmic drugs?
Either Beta-adrenergic blockers or Beta-receptor antagonists (ex: esmolol, propanolol)
What term denotes the property of matter causing it to return to its resting state after deformation by an external force?
Elasticity
According to P & K, what ventilator modes provide partial ventilatory support?
IMV, SIMV, PSV, APRV, BiPAP, MMV
Name the 6 ventilator items that are evaluated in ventilator dependency and adverse factor scores of Morganroth and colleagues.
FIO2, PEEP, Static compliance, Dynamic compliance, delivered ventilator VE, triggered respirations (an adverse factor score of 55 was found to best separate weaning success from failure)
The ATS official statement entitled Evaluation of Impairment Disability Secondary to Respiratory Disorders provided what spirometry and DLCOsb ranges for labeling an individual "moderate impairment"?
FVC of 51-59% of predicted, or FEV1 or DLCO of 41-59% of predicted, or FEV1/FVC% of 41-59% (mild - FVC, FEV1, or DLCO of 60-79% of predicted or FEV1/FVC% of 60-74%; severe - FVC < 50% of predicted, FEV1 or DLCO < 40% or FEV1/FVC% < 40%)
Aerosol holding chambers such as ACE and Aerochamber have been shown to eliminate most patient-generated errors such as poor coordination of MDI actuation and inhalation. Name two patient-generated errors that are not eliminated by aerosol holding chambers.
Failure to shake the MDI before activation, failure to perform a sufficient breath-hold
What is meconium?
Fecal material in amniotic fluid
Name three things that can be determined by amniocentesis.
Fetal maturity, genetic abnormalities, Rh isoimmunization, fetal status
When using ultrasonic nebulizers, why are flat transducers preferred over focusing transducers for administering small volumes of solutions?
Focusing transducers require a constant water level to maintain specified output, flat transducers do not
What is the main source of sulfur oxides in the atmosphere?
Fossil fuel power stations
Sleep-disordered breathing and an AHI of > 50 is associated with a two-fold increase in automobile crashes. What is the relationship between automobile crashes and cellular telephone usage while driving?
Four to five fold (10-12 fold for alcohol)
In the 1950's, what was the average life expectancy for a child with CF?
Four years
The single-breath nitrogen washout test is also referred to as what?
Fowler's test
The diagnostic criteria for obstructive sleep apnea includes a polysomnographic monitoring that demonstrates > 5 AHI and accompanied by at least one of several other symptoms. Name any two symptoms on the list.
Frequent arousals from sleep, bradycardia or tachycardia, SaO2 desaturation, mean sleep latency of < 10 minutes
In addition to the hexose called glucose, what are the other two hexoses?
Fructose and galactose
What is the laryngeal reflex response to stimulation?
Glottic closure
What are the most common laryngeal injuries associated with ET intubation?
Glottic edema or vocal cord inflammation (20-30%), laryngeal & vocal cord ulcerations (20-50%), vocal cord polyps & granulomas (up to 42%), vocal cord paralysis (3-5%)
What is the name of the process by which amino acids are converted into carbohydrates?
Gluconeogenesis
What are the 3 criteria of acceptability for a FVC?
Good start of test, no cough (especially during 1st second), no early termination
Who first said that the diffusion of gases through liquids is inversely proportional to the square root of the gas density?
Graham (density = GMW/22.4)
In nosocomial sinusitis associated with nasal tubes, what type if bacteria is usually responsible?
Gram negative bacilli
In hospital-acquired pneumonias, what two types of bacteria are most commonly implicated?
Gram-negative bacteria and staphlococcus (klebsiella, E.coli, enterobacter, proteus, and serratia, S.aureus, S.pneumoniae)
PEEP threshold resistors can be classified as what two types?
Gravity dependent (underwater seal, weight ball), non-gravity dependent (spring loaded valves)
What is the name of the film composed of polysaccharides and bacteria that form on the surface of artificial devices such as artificial airways?
Gylcocalyn
According to P & K, state the rate ranges and how gas movement is achieved in the three main types of high frequency ventilation.
HFPPV - 60-150/min - convection, HFJV - 60-1600/min - convection, HFO - 60-3600/min - diffusion
Name 5 types of high frequency ventilation described by McPherson.
HFV (60-150/min(, HFPPV (60-100/min), HFJV (100-200/min), HFFI/HIFI (adults100-200/min, infants 600-1800/min), HFO (1-50 Hz or 60-3000/min)
What is the Engstrom Edith?
HME
What does the acronym "HCFA" stand for?
Health Care Financing Administration
What are the two major thrusts of preventative medicine?
Health promotion and disease prevention
Determination of the apgar score is based on what five observations?
Heart rate, respiratory rate/effort, muscle tone, reflex irritability, color
Name 4 types of artificial noses.
Heat & moisture exchangers (HME), heat & moisture exchanging filters (HMEF), hygroscopic condenser humidifiers (HCH), hygroscopic condenser humidifier filters (HCHF)
What do you call the energy required to transform a solid directly to a gas?
Heat of sublimation (equals heat of fusion and vaporization)
Prior to binding to a steroid, the glucosteroid receptor is in an inactive state because it is attached to what protein?
Heat shock protein 90 (hsp90)
What is pyrolysis?
Heat-induced decomposition of organic compounds in the absence of oxygen?
The Bird model 3000 is an example of what type of humidifier?
Heated wick (high temp alarm at 40 degrees C)
Name 4 parameters which are used to predict normal values for spirometric measurement of pulmonary function.
Height, age, gender, ethnicity
In relation to the hemoglobin molecule, what does the term "zwitter ion" mean?
Hemoglobin is capable of either donating or absorbing a H+, thus acting as a buffer.
What is the most common symptom from pulmonary arteriovenous fistula?
Hemoptysis (recurrent)
What are some early complications associated with tracheostomy?
Hemorrhage, aspiration, sub-Q emphysema, pneumothorax, pneumomediastinum
What term means an accumulation of blood in the pleural cavity?
Hemothorax
Whose gas law determines the amount of oxygen that exists in the dissolved form in blood?
Henry's law
Whose gas law predicts how much of a given gas will dissolve in a liquid?
Henry's law
Give an example of a schedule 1 drug.
Heroin, Marijuana, LSD, Peyote, Mescaline
By what trade name was the MDI form of Pirbuterol released by 3M Pharmaceuticals in the late 1980's?
Maxair
When looking at a patient chart, you note that one of the lab tests reports a dibucaine number of 50. What does this tell you about the genetic makeup of this individual?
Heterozygote for abnormal pseudocholinesterase (<30 - homozygote, >70 - normal)
Name any three chronic diffuse infiltrative diseases that Farzan lists as miscellaneous.
Histiocytosis X (eosinophilic granuloma of the lung), Alveolar proteinosis, Pulmonary hemosiderosis
What are the two criteria listed by the FDA for the administration of Nebupent?
History of one or more episodes of PCP, peripheral CD4 count of <200/mm3 (use first reported by Montgomery in 1987)
How does cyanide poisoning affect oxygenation and what is the name of this condition?
Histotoxic hypoxia, primary defect occurs at the site of internal respiration by interfering with biochemical respiration
What is the mechanism of inactivation that makes Atracurium and Cistracurium desirable in patients with liver and kidney disease?
Hoffman Elimination (pH & temp dependent but doesn't depend on enzymes)
What term is usually used to describe coarse reticular densities seen on CXR?
Honey combing
The Bear neonatal volume monitor introduced in 1988 provides continuous monitoring of VT. What type of volume measurement device is incorporated in this unit?
Hot wire anemometer (accurate over a flow range of 0.15 -20.58 L/min with a volume of 1-100 mL)
According to P & K, what are the 3 indications for humidity therapy?
Humidification of dry gases (> 4 L/m), delivery of heated humidified gas to artificial airways, reduction of airway resistance during exercise induced asthma or nocturnal asthma (heated humidity)
What is the meaning of the terms hypertonic, isotonic, and hypotonic?
Hyper = greater tonicity, hypo = lesser degree of tonicity, iso + similar degree of tonicity
What is the shape of the oxymyoglobin dissociation curve?
Hyperbolic (no possibility of cooperativity because myoglobin is a monomer, PO2 has to fall below 10 mmHg before significant desaturation occurs)
Name any two of the three conditions during cardiac resuscitation where the administration of Ca++ is still allowed.
Hyperkalemia, hypocalcemia, calcium channel blocker toxicity (overdose)
What is the term for excessive blood oxygen content?
Hyperoxemia
What is meant by the term "atopy"?
Hypersensitivity state characterized by excessive amount of IgE antibodies
Name five possible complications of acute use of corticosteroids.
Hypokalemia & alkalosis, fluid & sodium retention, hyperosmolar non-ketotic coma, hypertension, clinical diabetes mellitis, acute severe psychosis, proximal myopathy, glaucoma, pancreatitis, cerebral edema
Diuretic therapy, diarrhea, and certain kidney problems can cause a low blood sodium level. What do you call a low blood sodium level?
Hyponatremia
Name 5 complications associated with endotracheal suctioning.
Hypoxemia, cardiac arrhythmias, hypotension, atelectasis, mucosal trauma, contamination/infection, increased intracranial pressure
Name and 5 causes of impaired mucociliary transport.
Hypoxia or hyperoxia, cuffed ETT, dehydration, electrolyte imbalance, infection, loss of ciliated epithelium, inhaled drug gases, cigarette smoke, anesthetics & analgesics, pollutants
Name any 4 of the 10 dimensions of personality functioning identified by the MMPI.
Hysteria, depression, hypochondriasis, psychopathic deviance, gender identification, paranoia, psychasthenia, schizophrenia, mania, social introversion
Recruitment of eosinophils and neutrophils from the blood to the lung involves ICAM-1 and VCAM-1. What are ICAM-1 and VCAM-1?
ICAM-1 - Intercellular adhesion molecule 1, VCAM-1 - Vascular adhesion molecule 1
According to Farzan, what are the four drugs that are used in the four-drug regimen for treating TB?
INH, rifampin, pyrazinamide, ethambutol (ethambutol dropped if drug sensitivity shows no evidence of drug resistance, pyrazinamide dropped after 2 months, INH & rifampin continued for 4 additional months)
Name any four of the six goals of breathing exercises.
Improve abdominal breathing; control respiratory rate; assist patient in relaxation; increase strength, coordination, & efficiency; prevent or reverse atelectasis; mobilize & maintain mobility of chest
According to Egan, what are the three indications for IPPB?
Improve lung expansion, provide short-term ventilatory support, aid in the delivery of aerosolized drugs
Explain when serum lipase levels may be elevated?
In acute pancreatitis - appear later, rising slowly, helps confirm diagnosis of pancreatitis
With regards to the A-a gradient, what is the response to an increase in FIO2 if shunt is the pathophysiologic process?
Increase (widening; diffusion defect and V/Q mismatch show the disappearance and narrowing of A-a gradient respectively)
Describe the Haldane effect.
Increase O2 decreases Hb affinity for CO2
What are two possible disadvantages of using the Cole pediatric tube?
Increase in deadspace as a result of the larger diameter, potential for laryngeal dilation when used for prolonged periods
Describe the Bohr effect.
Increased PCO2 and decreased pH decreases HbO2 affinity
Name two side effects of neostigmine (muscarinic effects).
Increased airway secretions, decreased BP secondary to decreased HR and vasodilation
What is a left shift?
Increased number of young neutrophils, usually bands
What is the effect of exercise on blood pressure?
Increases systolic, decreases diastolic
Define COPD.
Individuals with chronic bronchitis or emphysema who have indicated obstruction to airflow on a spirogram
What 2 distinct skin reactions are necessary for the PPD test to be considered positive?
Induration (raised welt) of 10mm in diameter, an area of erythema (redness)
What is the most commonly used prophylactic regimen in the prevention of PCP by inhaled pentamidine?
Inhalation of 300mg dissolved in 6 ml sterile water Q4 weeks (best given by Respirgard II because there is a filter on the exhalation port; indicated in both primary, < 200 T-4 lymphocytes/mm3, and secondary prophylaxis)
What effect on nitric oxide production would an inhibitor of nitric oxide synthase such as methylene blue have?
Inhibits (decreases) the action of NO (inducible NOS is stimulated by endotoxin and inhibited by glucocorticoids; cGMP - specific phosphodiesterase inhibitors potentiate NO)
According to Branson, what are the 4 parts of a tracheostomy tube?
Inner cannula, outer cannula, obturator, cuff
Name the four visual indicator lights on the Bourn humidifier.
Inoperative, add water, normal, wait
What is the name of the part of a prescription that contains the name and amount of the drug being prescribed?
Inscription
According to Egan, state 6 of the 10 factors that will affect delivery of a drug to the lung.
Inspiratory flowrate, respiratory rate, inspiratory pattern, airway caliber, nose vs. mouth breathing, mask vs. mouth piece delivery, type and ease of use of nebulizer, drug formulation, humidity, patient ability to coordinate/comprehension
Name 3 alternative terms for "maximal inspiratory pressure".
Inspiratory force, negative insp. force, maximum insp. force, peak negative pressure, maximal static inspiratory pressure
What are the 3 primary determinants of VC?
Inspiratory muscle strength, lung elastic recoil, chest wall mechanics
What is diffusion?
Intermolecular mingling resulting from the random collision of fluid molecules producing a homogenous mixture
Which nerve provides sensory innervation to the epiglottis and larynx?
Internal branch of the superior laryngeal nerve
Name 2 methods used to block the laryngeal nerve.
Internal method (anesthetic soaked pad get in the periform fossae bilaterally utilizing curved Jackson forceps); Feasible method (inject 2-4mL of 1% lidocaine with 23 gauge needle through thyrohyoid ligament)
At birth, what vertebral level does the rima glottidis occupy?
Interspace between the 3rd and 4th cervical vertebrae (infants vocal cords are concave and have an anteroinferior incline)
What is the earliest form of pulmonary edema called and where, microscopically, is the fluid found?
Interstitial edema, in the peribronchial and perivascular spaces
What term has been referred to as "the communion of two hearts"?
Intimacy
What group of drugs is known to have a "gastropulmonary mucokinetic vagal" reflex action?
Iodides (also guaifenesin - glyceryl guaiacolate; SSKI contains 1000mg/ml, so a dosage of 10 drops QID would deliver 4g. Complications include: iodine sensitivity in the form of acneiform rash, and hypothyroidism in 5% of patients)
What are two types of atomic bonding?
Ionic (electrons are exchanged), covalent (electrons are shared in pairs)
Under what conditions is the unit milliequivalents per liter equal to millimoles per liter?
Ions with a univalent charge
What is the only currently approved anticholinergic bronchodilator in the U.S.?
Ipratroprium bromide (Atrovent)
The most common type of anemia is the result of what deficiency?
Iron
During the 1940's and 1950's many mechanical devices were introduced as assistance to patients suffering from poliomyelitis. Name the four listed in Hodgkin's book.
Iron lung, chest cuirass, rocking bed, pneumobelt
What are the two ways that carboxyhemoglobin interferes with oxygen transport?
It binds competitively to the Hb, shifts O2Hb curve to the left (same with metHb)
What is the unique feature of Bard Trachmate neonatal/pediatric ETT?
It contains an encapsulated magnetic metal marker and a battery-operated sensing instrument that is used to produce an audiovisual signal that correlates with proximity of the tube marker to the instrument
How much faster does gas in the center of a tube move than the average flow when flow has a Reynold's number greater than 2,000?
It doesn't - turbulent flow does not have the high axial flow velocity characteristic of laminar flow
Describe the Sakalad Airway.
It has a blunted pharyngeal end with two openings and a much smaller flange at the nasal end
In regards to ABG's, what is meant by standard deviation?
It is the average calculated result or value of a given parameter as well as the dispersion of values around that average
What effect will the terminal flow on the PB-PR2 have on the delivered FIO2 when the machine is operated in the air-dilution mode?
It will increase the FIO2 (60 cmH2O working pressure)
How will the addition of water vapor to a volume of gas affect total gas volume?
It will increase total volume
Describe the features of the Bird Mark 14.
It's a Mark 10 with a Mark 9 pressure magnet that allows peak pressures of around 200 cmH2O
In the meter-kilogram-second system or Systeme Internationale, what is the unit used to measure work?
Joule (1 Joule = 1 Newton X 1 meter)
What is the best defined and recognized of the congenital ciliary dyskinesias?
Kartagener's syndrome (characterized by bronchiectasis, chronic sinusitis, and situs inversus)
What theory states that matter is composed of molecules or atoms or ions that are in constant motion?
Kinetic theory of matter
What test is described as the development of granulomas at the site of injection of a specific antigen only in patients with sarcoidosis?
Kveim test
Name the spinal deformity in which the spine has an abnormal anteroposterior curvature?
Kyphosis
Surfactant is synthesized and stored in what part of the alveolar type II pneumocytes?
Lamellar inclusion bodies
If all other conditions are equal (pressure, flow, tube size), what is the determinant of flow for laminar and turbulent conditions respectively?
Laminar determined by gas viscosity, turbulent determined by gas density
What term describes a streamlined molecular flow of fluid in which there is little intermolecular friction between molecules at the center of a tube?
Laminar flow
What are the two types of differential pressure flow sensors?
Laminar flow devices (employ a fixed resistance element), turbulent flow devices
There are several devices (signal generators) that are available to calibrate spirometers. Name two.
Large volume syringe, sine-wave rotary pumps, automated syringes, explosive decompressive devices, biologic controls
What two methods may be used to directly measure nebulizer output?
Laser counter, staged cascade impactor
What is the name of the spiral stainless steel tube by Mallinckrodt that was designed for use during laser surgery?
Laser-Flex
What law stated that flow varies directly with cross-sectional area and velocity. That is, if cross-sectional area increases, flow will increase or velocity will decrease.
Law of continuity
What law quantifies the flow of a fluid moving through a tube?
Law of continuity ( A1V1 = A2V2; basis for calculating cardiac output)
What single factor is the most important contributor to the neuropsychologic deficits in COPD patients?
PaO2
In what two organs is the intracellular concentration of COMT highest?
Liver and kidney (because of COMT, catecholamine duration of action is 11/2 -3 hrs; gut and liver also have enzymes which conjugate catecholamines at the carbon-4 site with either sulfate or glucaronide)
Although elevated AST levels occur in many diseases, the enzyme is used primarily for assessing what?
Liver disease and possible MI
When comparing traditional volume ventilation to high frequency ventilation, what two theoretical advantages does HFV have?
Lower peak pressures may reduce complication, non-bulk flow mechanisms may improve V/Q matching
When referring to the "best" PEEP approach, what is the primary end point?
Lung compliance (preferred PEEP - max VO2, appropriate PEEP - PaCO2-PETCO2, least PEEP - lowest level to maintain PaO2 = 60 with FIO2 50%)
According to Rau, there are several considerations that fall under the effect of the pattern of inhalation on particle deposition. Name three.
Lung volumes at beginning and end inspiration, TI and flow rate, mouth vs nose breathing, adjunct maneuvers such as breath hold
What two muscarinic receptors are blocked by anticholinergics?
M1 on the smooth muscle membrane and M3 on the parasympathetic ganglion
What is another name for MVV?
MBC (maximum breathing capacity)
What is macrocytic anemia?
MCV is high, RBCs larger than normal
The presence of a Ck-MB bond on electrophoresis is characteristic of what?
MI
What diseases are Ck elevated in?
MI and various skeletal muscle diseases
What is the most common cause of left ventricular failure?
MI or ischemia
The FAA allows pilots with OSA to continue flying if they are treated with CPAP and can pass what test?
MWT (Maintenance of Wakefulness Test)
Bloody fluid obtained by thoracentesis in a patient without a history of chest trauma would be suggestive of what illness?
Malignancy or pulmonary embolism
During the "early phase" of an asthmatic reaction, what cell releases histamine, prostaglandin D2 and leukotriene C4)
Mast cells (these cells release histamine, ECFA, NCF, bradykinin, lymphokines)
What is the Karvonen method?
Method for calculating exercise target heart rate (max. HR on exercise test - resting HR = HR range x .70 = product; product + rest HR = THR)
What are the 4 primary elements to consider in regard to a quality assurance program?
Methodology, instrument maintenance, control methods, testing and/or sampling technique
According to Ruppel, each laboratory should have a written quality assurance program which includes what 4 issues?
Methods employed for specific tests, limitations of the procedure, indications or schedules of maintenance, quality control materials or signals to be used, action to be taken if controls exceed specific limits, specific guidelines to be followed as to how tests are to be performed
Name any two of the non-depolarizing neuromuscular blockers that are considered long-acting.
Metocurine, Pancuronium, Pipecurium, Doxacurium, Tubocurarine
What type of anemia is iron deficiency?
Microcytic and hypochromic
When anemia is present and the MCV (mean cell volume), MCH (mean cell Hb), and MCHC (mean cell Hb concentration) are abnormally low, what type of anemia is present?
Microcytic, hypochromic anemia (the red blood cells are smaller than normal and contain a lower concentration of Hb)
State the three classifications of hemoptysis by volume of blood expectorated.
Mild < 25 ml/24 hrs, moderate 25-500 ml/24 hrs, massive > 500 ml/24 hrs
Name 3 examples of straight laryngoscope blades.
Miller, Wis-Hipple, Flag
In addition to a forced expiratory effort of at least 6 seconds and an abrupt start of test, what other two criteria should be met to accept a FEV test?
Minimum of 3 acceptable efforts obtained ((2nd largest FVC/largest FVC) x 100 > 95%), PEF should be consistent among tries
Which state within the U.S. has been the world leader in developing programs to eliminate smoking in the general population?
Minnesota
What is the MMPI and how many items does it contain?
Minnesota Multiphasic Personality Inventory with 566 items
CLIA 88 specified that three categories based on test complexity exist. To what category does automated blood gas analysis belong?
Moderate (categories are: waived test, moderate complexity - don't require operator intervention during the analytic process, and test of high capacity)
What is the most common type of O2 concentrator?
Molecular sieve (max flow of concentrators 2-5 L/m)
What is ozone?
Molecules made of 3 oxygen atoms (O3)
Wheezes can be classified as random or simultaneously. What other terms are used to describe these factors?
Monophonic (random) - can be insp. or exp. and may start and end at different times (asthma); Polyphonic (simultaneous) - exp. sounds consisting of several harmonically unrelated tones that tend to start & end simultaneously (normal patients at the end of FVC)
Define the term count mode.
Most frequently occuring particle size in a distribution
What is the commonly used term that refers to the side port at the distal end of an endotracheal tube?
Murphy eye
At a genetic level, what is the cause of cystic fibrosis?
Mutations of a single gene in the long arm of chromosome 7 (mutation of F508 results in the deletion of phenylalanine at position 508 of the protein named cystic fibrosis transmembrane conductance regulator (CFTR). This mutation is responsible for about 70% of CF cases)
What does an abnormality in the S-T segment of an ECG usually indicate?
Myocardial ischemia
What is the most common form of muscular dystrophy in adults?
Myotonic dystrophy
How does the presence of a nasogastric tube increase the development of nosocomial infection?
NGT increases likelihood of gastric reflux, impairs swallowing, serves as conduit for bacteria to move into oropharynx
According to the AARC CPGs, what are the 4 absolute contraindications for fiberoptic bronchoscopy?
No patient consent (unless medical emergency and patient not competent); absence of experienced bronchoscopist; lack of adequate facilities & personnel to care for emergencies such as cardiac arrest, pneumo, bleeding; inability to adequately oxygenate the patient
A patient receiving LOX at home wants to take a leisurely trip across country and has the choice of Greyhound or Amtrack. Will Greyhound allow him to check his stationary system as baggage?
No, he would have to arrange for liquid oxygen at each stop-over or at times to replenish his portable tank. (Amtrack will allow stationary systems to go with the patient as long as the patient travels in non-smoking sections of the train)
What is normocytic, normochromic anemia?
Normal MCV, MCH, MCHC
What term denotes infections which are hospital associated?
Nosocomial
When reporting the results of a spirometry which values do not have to come from the same curve and which values should be obtained from the single acceptable "best-test" curve?
Not same curve - largest FVC, FEV1; "best-test" curve - FEF25-75%, FEF50%, instantaneous expiratory flowrates
What are standard conditions?
O degrees Celcius at 1 atm
Define Oxygen cost of breathing (OCB).
OCB = VO2(spontaneous) - VO2(controlled ventilation); the relative proportion of Oxygen consumed by the respiratory muscles as compared to the body as a whole. A threshold of 15% has best sensitivity & specificity to predict unweanability
What 3-4 types of individuals is sleep apnea more prevalent in?
Obese, males, older individuals, hypertensive population
What is the single most important risk factor for obstructive sleep apnea?
Obesity (neck sized > 17 for men, and > 16 for women; BMI = 30 plus or minus 6 for OSA patients, 27 4 for non-OSA patients)
Name any 2 of the items assessed by the "GOMER Assessment Scale".
Old chart weighs more than 5 lbs., ties foley catheter into pajama strings, has seizure and never drops his cigarette, asks for cigarette during pulmonary function test, BUN is higher the IQ, PO2 is less than respiratory rate (Samuel Shem's House of God, GOMER - get out of my emergency room)
Name two brands of ETT fixation devices.
Olympic Endolok, Mallinckrodt Tracheal Tube Restraint, Dale Endotracheal Tube Holder, Posey Endo-fix, Respironics Secure Easy
State Avogadro's law.
One gram-atomic, one gram-molecular, or one gram-ionic weight of a substance contains 6.02 x 1023 particles of that substance.
What is meant by the term "molal"?
One mole per 1000 grams of solvent (molar = 1 mole/liter of solution)
Hb-S is structurally identical to Hb-A with the exception of what?
One of the 146 amino acids in the Beta chains of the Globin is different
In order to measure the maximum sustained ventilatory capacity, what type of device allows isocapneic hypernea?
One of which prevents hypocapnia by returning some of the patient's CO2
Define milliequivalent.
One one-thousandth of the molecular weight of a substance in grams divided by its valence.
Define millimole.
One one-thousandth of the molecular weight of a substance.
What percent of smokers develop disabling airflow obstruction?
Only about 15% (in 1965, 40% of adults smoked; in 1987, only 29%)
In what percent of sarcoidosis patients do significant pulmonary symptoms develop?
Only about 25% (1/4)
What are the two operational controls found on the IPV (Percussionaire Intrapulmonary Percussive Ventilator - 1)
Operational pressure (20-50psi), impact (peak) pressure
What is the source of the surfactant known by the trade name of Survanta?
Organic solvent extracts of animal lung surfactant (contains SP-B and SP-C along with the surfactant lipids, produces quicker improvements in oxygenation than Exosurf. Exosurf does not contain these proteins)
Dr. Tom Petty, in the National Mucolytic Study, published results showing that iodopropylene glycerol was effective as an oral agent on cough symptoms in COPD patients. What is the trade name of this drug?
Organidin
What are the three sections of the pharynx?
Oropharynx, nasopharynx, laryngopharynx (hypopharynx)
What do you call dyspnea that occurs when a person is lying down?
Orthopnea (causes - heart failure, advanced pulmonary disease, bilateral diaphragmatic paralysis, obesity)
What term is used to describe the force driving solvent molecules through a semi-permeable membrane?
Osmotic pressure
According to P & K, the major determinants of ability to wean can be classified into what three categories?
Oxygenation, ventilatory pump function, neuropsychiatric status
Name any three methylxanthines that are alternatives to theophylline.
Oxytriphylline, glyphylline, diphylline, dynophylline, aminophylline
In the context of COPD sex education, what do the initials PLISSIT stand for?
P-permission given, LI-limited information, SS-specific suggestion, IT-intensive therapy
What is the combined gas law equation?
P1V1/T1 = P2V2/T2
What term is used to describe the lowest concentration of methacholine that results in a FEV1 reduction of 20%?
PC20
Name three products of the cyclooxygenase pathway that decrease vascular tone and pulmonary smooth muscle, and inhibit inflammatory cell function in general.
PGD2, PGE2, and PGI2
Which of the prostaglandins plays an important role in the perinatal period by constricting the patent ductus arteriosus?
PGE2 (check against Burgess & Chernick re: PGI2)
During the latter stages of NREM sleep in healthy individuals, what changes are observed in PO2 & PCO2?
PO2 decreases, PCO2 increases by about 5 torr
With certain conditions such as CHF, cor pulmonale, and erythrocythemia, the patients may qualify for home O2 at a different PaO2 and SaO2 than those patients without these conditions. What are these different values?
PaO2 56-59, SaO2/SpO2 less than or equal to 89%
According to P & K, what is the PaO2 and SaO2 of blood leaving the placenta by the umbilical vein?
PaO2 = 29 mmHg, SaO2 = 80%
What diseases may serum amylase be elevated in?
Pancreatic carcinoma (usually late in the disease); diabetic ketoacidosis; and diseases of the gallbladder, stomach, and small intestines
Name 3 mechanisms employed to allow IMV?
Parallel flow or open circuit, continuous flow or closed circuit, demand valve
What do Part A and Part B of the Medicare program provide for respectively in regard to what services are paid for?
Part A is primarily inpatient hospital care with limited nursing home service and some health services. Part B covers physician services, physician-ordered supplies & equipment and certain ambulatory care.
With respect to gas diffusion through semipermeable membranes, what is "dynamic equilibrium"?
Partial pressure of the gas is equal on both sides of the membrane and net movement stops
Define Mass Median Diameter (MMD).
Particle size above and below which 50% of the mass of particles are found (ie: the size particle that evenly divides the mass in the distribution)
According to Egan, what are the four requirements that must be met for IPPB to be effective?
Patients must be carefully chosen, indications for therapy be specifically defined, goals of therapy by clearly understood, treatment be properly administered by a trained RCP
Name 3 contraindications for the EOA and EGTA.
Patients who's unconsciousness can be rapidly reversed, patients who are semi-conscious, patients shorter than 5 feet tall (balloon would be in stomach), for use > 2 hours
According to Egan, name 4 of the 5 contraindications of using heat and moisture exchangers.
Patients with thick, copious, or bloody secretions; patients with an expired VT < 70% of the delivered VT; patients with body temps < 32 degrees C; patients with VE > 10 L/min; during aerosol treatments given via the patient circuit
In what units is phase III of an expired washout capnograph expressed?
Percent change in CO2 per liter volume (either time or volume may be recorded in a routine capnograph)
What term encompasses the effects and interactions of drugs within the body?
Pharmacodynamics
What is the term that refers to the study of the interrelationship of genetic differences and drug effects?
Pharmacogenetics
What term refers to the study of the interrelationship of genetic differences and drug effects?
Pharmacogenetics
What is the term that describes the absorption, distribution, breakdown, and elimination of drugs in the body?
Pharmacokinetics
What does PTL(A) stand for?
Pharyngeal Tracheal Lumen Airway
What two families or drugs are most often associated with NMS?
Phenothiazine, butyrophenone
What is the active ingredient of the nasal spray known as Dristan?
Phenylephrine (0.5%)
What membrane-bound enzyme is responsible for the release of free fatty acids including arachidonic acid?
Phospholipase A2 (requires intracellular calcium being available)
Name any three specific enzymes or factors that are inhibited by corticosteroids.
Phospholipase A2, cytokines such as IL-1, IL-2, & IL-3, tumor necrosis factor(TNF-1), granulocyte-macrophage colony stimulating factor(GMCSF), suppression of secretogogues
What is the main producer and regulatory factor of atmospheric oxygen?
Photosynthesis
Name four techniques that can be used to diagnose airway damage following extubation.
Physical exam, simple neck radiography, air tomography, flouroscopy, laryngoscopy, bronchoscopy, PFT's
Name any 4 syndromes, named after their discoverers, that can make intubation difficult.
Pierre Robin, Treacher Collins, Apert's, Klippel-Feil, Anderson's, Beckwith's, Binder's, Carpenter's, Chotzen's, Crougan's, Down's, Christ-Siemens-Touraine, Ellis-vanCreveld, Farber's, Goldenhar's, Golin-Goltz, Hallervorden-Spatz, Herlitz's, Hurler's, Larsen's, Leopard, Meckel's, Moebius, Noack's, Patau's, Pompe's, Pyle's, Silver-Russel, Smith-Lemil-Opitz, Sotos's, Stevens-Johnson, Turner's, Urbach-Wiethe, Welander's, Werdnig-Hoffman, Behcet's
When determining TLC by radiographic techniques, what two methods are used to calculate TLC?
Planimetry method (described by Harris, et al), Ellipsoid method (described by Barnhard et al)
What is the term that describes the situation where dyspnea in an upright position improves when lying down?
Platypnea (caused by vascular abnormality in the lung)
What technical term describes air or gas inside the cranium?
Pneumocephalus
Why do patients with pneumococcal pneumonia often expectorate no sputum?
Pneumococcal pneumonia does not cause inflammation of the bronchi and bronchioles, but in the alveoli, and therefore very distal in the respiratory system and hard to expectorate
An obvious sternal bulge that develops acutely in the neonate on positive pressure is indicative of what disorder?
Pneumomediastinum
What is the most common device used for measuring VT in infants?
Pneumotachometers
According to Branson, there are four distinctly different devices for measuring gas flow rates. Name them.
Pneumotachometers, thermistors (PB7200), turbinometers, sonic devices (LS75)
According to the AARC CPGs, what are the 8 hazards/complications of spirometry?
Pneumothorax, increased ICP, syncope, chest pain, paroxysmal coughing, contraction of nosocomial infections, decreases SaO2, bronchospasm
How do you spell the name of the man who described the relation between pressure and airflow in the airway when airflow is laminar?
Poiseuille (during turbulent airflow, pressure is proportional to the square of air velocity)
What law governs the flow of fluids through tubing systems?
Poiseuille's law
Name and provide the formula for calculating the laminar flow through a tube.
Poiseulle's law V = (r4P)/(8l)
What are two types of covalent bonding?
Polar, nonpolar
What term is used to describe an abnormal elevation of RBC count?
Polycythemia
What is another name for primary polycythemia?
Polycythemia vera
What is the composition of the insert material of most HCH's?
Polypropylene or paper (and are treated with lithium chloride or calcium chloride)
What are the disadvantages of aerosolized moisture to the whole interior of an incubator?
Poor visibility and fogging, wet linens, facilitates growth of gram - organisms
An ETT primarily exerts pressure at what three locations?
Posteromedial portions of the true vocal cords, posteromedial surface of the arytenoid cartilages, posterolateral aspects of the cricoid cartilage
What infants are at greatest risk for meconium aspiration?
Postterm and post mature infants
What is the chief cation occuring within cells?
Potassium
According to Kacmarek, what properties should the ideal pharmacologic agent possess for use in maintaining patients receiving mechanical ventilation?
Potent CNS depressant, minimal CV side effects, potent euphoric, strong analgesic, totally reversible (morphine)
What do you call the special type of synergism where one drug has no effect but can increase the activity of another drug?
Potentiation
What do you call the special type of synergism where one drug has no effect on its own but can increase the activity of another drug?
Potentiation
According to Chatburn, what are the basic areas of a ventilator classification system?
Power input, power transmission or conversion (drive mechanism), control scheme, output, alarms
What are the 3 parts of an ultrasonic nebulizer?
Power unit, transducer, fan
What are the two ways in which REE may be determined?
Prediction equations such as Harris-Benedict equation; Indirect calorimetry measurements
What is the purpose of Reynold's formula?
Predicts laminar or turbulent
What does the acronym PROM stand for?
Premature Rupture of Membranes
According to Egan, what are the two major ways ventilators apply positive pressure to the airways?
Pressure generation, flow generation
Of all the modes of ventilation currently available, which one has received the most scientific investigation?
Pressure support
According to Chatburn, what are the four control variables?
Pressure, volume, flow, time
Define calibration.
Process in which the signal is adjusted to produce a known output (3 ways to calibrate: adjustment of analog output signal, adjustment of sensitivity of recorder, software correction or compensation)
What bronchodilator class does Bitolterol belong?
Prodrug (must be converted in the body to the active drug)
What is the definition of work?
Product of a force exerted on an object and distance that object moves in the direction of the force
The company, Union Carbide, uses a quality circle concept which they refer to as a "PRIDE" circle. What does the acronym "PRIDE" stand for?
Productivity through Recognition, Involvement, and Development of Employees
What kind of testing is required to externally evaluate each laboratory's performance?
Proficiency testing (proficiency testing samples must include 5 samples for each analyte or test and the lab must participate at least 3 times per year. 80% of acceptable measurement is required. Any lab with < 80% for 2 of 3 testing events will be subject to sanctions for the involved test)
Robbins suggests seven areas from which objectives arise. Name four.
Profitability, growth, market penetration, leadership, productivity, client satisfaction, social awareness
What drug was approved by the U.S. FDA in 1987 for the treatment of alpha-1-antitrypsin deficiency?
Prolastin (IV dose 60mg/kg/week)
If a patient with an Alpha1-antitrypsin deficiency has a level under 11 uM, what drug may be given to supplement his ATT level?
Prolastin (although Prolastin has been heat-treated, patients should be immunized against hepatitis B and screened for HIV)
What is the mechanism of action of class III antiarrhythmic agents?
Prolong phase 3 > lengthen refractory period (ex: Bretylium tosylate)
List 3 causes of decreased serum chloride.
Prolonged vomiting (HCA loss), metabolic acidosis, chronic respiratory acidosis, Addisonian crisis, certain kidney diseases
What is the advantage of using hexaflourenium along with succinylcholine?
Prolongs the duration of muscle paralysis (hexaflourenium is a plasma cholinesterase inhibitor)
What is the most effective positioning of a patient with bronchiectasis if the superior segments of the lower lobes are to be drained?
Prone with hips higher than shoulders (post seg Rt upper lobe - on left side; Rt middle lobe - on left side with foot of bed elevated; post basal segments - prone with foot of bed elevated; ant basal segments - supine with foot of bed elevated)
Name any four of the substances released by activated mast cells.
Prostaglandins, leukotrienes, histamine, platelet-activating factor, cytokines (tumor necrosis factor - alpha1 and interleukin-4)
Decreased albumin levels (hypoalbuminemia) is seen in which diseases?
Protein malnutrition; severe liver disease with a decrease in functioning liver tissue, chronic inflammation, severe acute disease; and kidney disease
Hemoglobin is eventually degraded into three components. Name two.
Protoporphrin IX, iron, globin (protoporphrinIX--> globin-->verdohemoglobin-->bilirerdin-->bilirubin)
What is a PC20?
Provocative concentration (usually methacholine) necessary to reduce FEV1 by 20% as compared to baseline
What is another name for bacterial tracheitis?
Pseudomembranous croup
Managing the surgical airway (can't intubate, can't ventilate) requires what 3 types of preparations?
Psychological, logistical, clinical
What do you call the area of study that explores the connections between the nervous system, the endocrine system, and the immune system?
Psychoneuroimmunology
In what cells are the earliest pathologic changes due to oxygen toxicity?
Pulmonary capillary endothelial cells
Significant hypoalbuminemia leads to loss of fluid from vascular spaces and causes what?
Pulmonary edema
What is the most common pulmonary pathologic finding at autopsy in large general hospitals?
Pulmonary embolism
The AARC CPGs for spirometry should be applied in what 4 settings?
Pulmonary function or research lab; at bedside acute, subacute, SNF; clinic, treatment facility of doc's office; workplace or home; public screening
Although high Ck values generally occur because of myocardial or skeletal muscle disease, for uncertain reasons high levels have occurred with what?
Pulmonary infarction, pulmonary edema
Give an example of a Type III or Immune Complex immune reaction.
Pulmonary vasculitis, systemic lupus erythematosus, extrinsic allergic alveolitis (also Type IV)
What term is used to describe an alternating succession of strong and weak pulses?
Pulsus alternans
What term is used to indicate a significant decrease in pulse strength during spontaneous inhalation?
Pulsus paradoxus
What class of drugs does methoxyamine fall into?
Pure alpha-1 agonist (drugs that increase coronary perfusion pressure - include epinephrine, norepinephrine, phenylephrine, or methoxyamine; high dose epi = 0.2 mg/kg, low dose = 0.02 mg/kg)
What is the name given to the non-adrenergic, non-cholinergic system which is inhibitory to bronchoconstriction?
Purinergic or peptidergic
State the Physiologic shunt equation.
QS/QT = (CcO2-CaO2)/(CcO2-CvO2); Clinical shunt equation = [(PAO2-PaO2) x 0.0031]/[C(a-v)O2 + ((PAO2-PaO2) x 0.0031)]
How frequently should the recorder accuracy for spirometers be checked?
Quarterly'
Other than Anectine, what other trade name is used for the drug succinylcholine?
Quelicin
What is the formula for calculating Reynold's number?
R = 2rvd/n where r = radius, v = average velocity, d = density, n = viscosity
What other term describes "active sleep" of infancy?
REM sleep
According to Egan, name 5 characteristics of HFPPV.
RR of 60-100/min, I:E of 1:3 or less, constant pressure generator, small VT (often anatomic VD), maintains positive pressure though intrapleural pressure usually remains subatmospheric
According to P & K, what should the initial RR & VT setting be when initiating mechanical ventilation?
RR: 8-12, VT: 12-15 ml/kg (restrictive RR: 12-20, VT < 10 ml/kg; decreased compliance RR: 12-20, VT < 10 ml/kg; COPD RR: 8-10, VT: 12-15 ml/kg)
Predicted lung volumes and capacities are based on statistical data from a group of individuals based on height, age, and sex. Predicted normal values may vary for lung volumes due to what other factors?
Race, ethnic background, socioeconomic factors, environmental exposures, occupation, place of residence (urban or rural)
Give three reasons why the preferred route of administering bronchodilator beta-adrenergic drugs is by inhalation?
Rapid onset, smaller doses as compared to oral, side effects are reduced, drug is delivered directly to target organ, inhalation is painless and safe
With volume assisted ventilation, what parameter is not clinician programmed but left up to the patient to determine?
Rate
What do the initials RPE and RPD stand for?
Rate of Perceived Exertion, Rate of Perceived Dyspnea
What is a therapeutic index and what is the value for penicillin?
Ratio of LD50:ED50, 100 for penicillin (1.5 - 2.0 for Digitalis)
Q-fever is caused by Coxiella burnetii, an organism found in wild animals, domestic livestock and occasionally cats. To what group of microorganisms does this organism belong?
Rickettsia
According to Branson, why are the lung bases the best place to auscultate following ET intubation?
Right mainstem intubation may obstruct the right upper lobe as well as the entire left lung
What term applies to a condition in which venous blood travels from the right heart to the left heart while not participating in gas exchange by perfusing ventilated alveoli?
Right to left shunt
Carlens and White tubes both have a tracheal hook. Who makes a similar tube designed to enter a mainstem bronchus, but does not have the carinal hook?
Robert Shaw
Name the 4 cardinal features of localized systemic inflammation in sepsis syndrome.
Rubor (generalized vasodilation with hypotension and low SVR), Tumor (capillary leak with soft tissue edema), Calor (fever), Functio laesa (loss of organ function)
How does a SNF differ from an intermediate care facility?
SNF - onsite registered nurses supervise at leas 2 shifts/day, ICF - onsite registered nurses supervise only one shift/day
During the initial assessment for a pulmonary rehabilitation program, the assessor records a dyspnea index of 4. What does this mean?
SOB walking 100 feet on level ground, dressing, or talking (1 = SOB with activity, 2 = SOB climbing hills or stairs, 3 = can walk at own pace, but not at normal pace without SOB)
If you are administering ribavirin, what device should be used and what dose should be given?
SPAG nebulizer, 6gm/300ml (2%), 12-18 hrs/day, 3-7 days
What is meant by the terms STPD, BTPS, and ATPS?
STPD = 0 degrees Celcius, 1 atm, dry; BTPS = body temp and pressure, saturated (37degrees Celcius, ambient pressure, saturated); ATPS = ambient temp and pressure, saturated
The Fahrenheit temperature scale is based on the coldest temperature that can be achieved by mixing what three things?
Salt, ice, water
What three substances , when mixed together, can result in a temperature of 0F and form the basis of the Fahrenheit scale?
Salt, water, and ice
Whose name is associated with the modern, compact pH electrode?
Sanz
Name any five lung diseases that fall into the category known as chronic diffuse infiltrative diseases.
Sarcoidosis, Immunologic, Environmental/occupational, Drug induced, Circulatory, Neoplastic, Aspiration related, Related to physical agents, Infections, Miscellaneous
Drugs are thought to produce their effects either by acting at some specific receptor site, or by acting diffusely at many tissues. What term is used to describe those that act diffusely?
Saturation-dependent (or nonreceptor drug, ex: alcohol, hypnotics, anesthetics, H2O, saline)
What drug is combined with Demerol to make "twilight sleep"?
Scopolamine
Name any two measurements of visceral protein status.
Serum albumin (half-life 21 days), Transferrin (half-life 10 days), Thyroid-binding pre-albumin (half-life 2 days), retinol-binding protein (half-life 12 hours)
Name 3 mechanical ventilators that, according to P & K, incorporate an end-expiratory hold that can be used to quantify auto-PEEP.
Servo 900C, Hamilton Veolar, Ohmeda Advent, Liquid Air Cesar
According to the 1988 AMA guidelines for defining severe impairment due to asthma, what criteria must be met?
Severe impairment on 3 successive tests performed at least 1 week apart (in the U.S., tests are usually spirometry and DLCO; in Europe, exercise testing is preferred)
By what 3 routes is Hepatitis B transmitted?
Sexual contact, parenteral exposure to contaminated blood, perinatal transmission from mother to child
What is the name of the method of plotting ABG electrode results of controls for pH, PCO2, and PO2 that assists in judging whether or not the electrode is "out of control"?
Shewhart/Levey-Jennings Plot
When evaluating a pressure-volume loop, what effect would a decrease in total patient compliance have on the loop?
Shift to the right
Name 4 types of adverse effects from drugs.
Side effects, toxicity, allergy, anaphylaxis, idiosyncrasy (paradoxical reaction), tachyphylaxis
What cuff material requires the least inflation pressure?
Silicon (latex requires greatest)
What is the composition of the anode in the Clark electrode?
Silver (accuracy range 40-100 2%; the tip of the electrode is covered with a polypropylene membrane. Cathode - platinum)
What information may serve as a cross-check to help decide if blood gas results are arterial or venous?
Simultaneous pulse oximetry
What is the most common method used to determine DLCO?
Single breath method
State 5 hazards of nasolaryngeal airways.
Sinusitis, otitis media, gastric insufflation (if too long), intubation of meninges (if head or facial trauma), occlusion of airway by secretions, tissue necrosis
How many different nitric odixe synthase isoenzymes exist?
Six (Ca+ dependent in vascular endothelium, cerebellum, adrenal tissue, and platelets; inducible Ca+ independent NO's in lung, hepatic kupffer cells, and macrophages)
The anatomic deadspace in a normal individual is about 150 mL. What three factors increase or decrease the value measured in a specific individual?
Size of the subject, posture (position) of the subject, magnitude of inspiration
What syndrome has been referred to as "the cardiac murmur syndrome of the 90's"?
Sleep Apnea Syndrome
In the context of obstructive sleep apnea, what does the acronym SDB stand for?
Sleep Disordered Breathing
What is an AHI of 5 or greater in combination with self reported hypersomnolence indicative of?
Sleep apnea syndrome
How does an Ovassapian airway differ from a William's airway?
Slitted guides that allow it to be slipped off the endotracheal tube without removing the 15mm adapter
What is the true unit of mass in the British system of measure?
Slug
Virazole, the antiviral drug ribavirin, was administered by the SPAG nebulizer. What do the initials SPAG stand for?
Small Particle Aerosol Generator (can hold up to 300 ml of solution)
Name 5 risk factors for perioperative pulmonary complications.
Smoking, pre-existing pulmonary disease, age, anesthetic time > 3.5 hrs., obesity, cardiac disease, upper abdominal surgery, NG tubes (PFT values suggesting increased risk: FVC < 70%, FEV1 < 70%, PEFR < 20L/min, FEV1/FVC < 65%)
List any four beneficial actions of Beta2-selective compounds.
Smooth muscle relaxation (bronchi, uterus), decreased PA pressures, increased mucociliary activity, decreased mediator release, decreased pulmonary edema, decreased muscarinic transmission
Who wrote "As it is not proper to cure the eyes without the head, nor the head without the body, so neither is it proper to cure the body without the soul"?
Socrates (humor has root from the word "umor" meaning liquid, heal comes from "haelen" meaning whole)
What is the chemical name of the "zeolite" pellets found in a molecular sieve oxygen concentrator?
Sodium-aluminum silicate
What is "dry ice"?
Solid carbon dioxide
According to Farzan, what are the two general categories of pneumothoraces?
Spontaneous, traumatic
What is the difference between sputum and phlegm?
Sputum is the substance expelled from the tracheobronchial tree, pharynx, mouth, sinuses, and nose by coughing or clearing the throat. Phlegm refers strictly to secretions from the lungs and tracheobronchial tree.
What 3 gram positive cocci are the most common respiratory bacterial pathogens?
Staphylococcus aureus, streptococcus pyogenes, streptococcus pneumoniae (AKA diplococcus pneumonia)
What are the two CNS side effects of atropine?
Stimulation at low doses, depression at high doses
What type of transducer operates on the principle of measuring the change in electrical resistance created when a fine wire is stretched?
Strain gauge transducer
What four factors are considered in Fick's law?
Surface area of the membrane, concentration gradient across the membrane, diffusion rate constant (dependent on both Henry's law and Graham's law), thickness of the membrane
According to McPherson, name 3 structures that can act as a baffle.
Surface of the water in a container, sides of a container, placement of a ball in the path of the aerosol
What intervention is required for a newborn with an apgar score of 4-6?
Sxn mouth and nose, stimulate, provide O2 with 5L/min face mask over nose and mouth (7-10 put under warmer, dry, sxn; 0-3 sxn, bag-mask ventilate, no improvement in 15-30 sec -> intubate)
According to Hodgkin, what are the three primary classes of bronchodilators currently in clinical use?
Sympathomimetics, Anticholinergics, Methylxanthines
What was the most common medical problem encountered during flight?
Syncope/near syncope
In a patient with thick, tenacious secretions, what is the most effective way to improve the character of secretions?
Systemic hydration
Of all the home care ventilators studied by Branson and Davis in their article reported in Dec. 1995 RC, which ventilator performed comparably to the PB7200?
T-Bird VS (with respect to WOB which performed best: LP10, LP6, or PLV102? LP-10)
The tip of an ETT should be between what two vertebral bodies when viewed on a chest radiograph?
T2 - T4 (carina @ T6; ETT position from teeth 23 - men, 21 - women)
What labels do the regulatory cells of the T-lymphocytes which either act as "helpers" or "suppressors" have respectively?
T4 (or CD4 positive) for helper T-cells, T8 (or CD8 positive) for suppressor T-cells
Anthropomorphic measurements are a way of estimating the body's basic fuel reserves. What fuel reserves are estimated by the triceps skinfold and the creatinine-height index respectively?
TSF = fat stores, CHI = skeletal muscle mass (also arm muscle circumference)
Name two brands of ETT changers.
TTX Tracheal tube exchanger (3 sizes for tubes 4.0>10.0), JEM 400 Endotracheal tube exchanger (used for tubes > 7.5 mmID)
What term describes the phenomenon where by the responsiveness to a drug becomes increasingly smaller?
Tachyphylaxis
What is the difference between tachyphylaxis and tolerance?
Tachyphylaxis (receptor desensitivation) occurs quickly and tolerance (probably "down regulation") requires more time
Give two reasons why acetylcysteine has not become popular as a mucolytic in the US.
Taste, odor, cost
What material comprises the membrane of the Severinghaus CO2 electrode?
Teflon
What 4 things does a plan do?
Tells what is to be done, when it is to be done, how it is to be accomplished, who is to do it
What changes of temperature and humidity occur above the isothermal saturation boundary during inspiration and expiration respectively?
Temperature & humidity decrease during inspiration and decrease during exhalation
What is the effect on temperature when a gas is rapidly compressed?
Temperature increases (heat of compression)
What is the name given to a pleural effusion that is large enough to cause significant displacement of the mediastinum to the opposite side?
Tension hydrothorax (severe dyspnea, hypotension from decreased CO, jugular venous distention)
What drug is found in the turbohaler?
Terbutaline (available in UK and Europe; 200 dose, effective at flows of 30 l/min)
What is the NAEPP report?
The "National Asthma Education and Prevention Program" report
What is the major difference between the first generation cephalosporins and the second and third generation cephalosporins?
The 2nd & 3rd generation drugs have much better gram-negative coverage
Classically, what is the most sensitive test in diagnosing diabetes mellitus?
The 3-hour glucose tolerance test (the standard glucose load is given and plasma levels of glucose are determined at 30 min, 1 hour, 2 hours, and 3 hours)
According to the AARC CPGs, bronchoscopy assisting should occur only under the direction of a physician who has been trained according to the guidelines endorsed by what organization?
The American Thoracic Society
What is the reason that Dr. Walter O'Donohue says that "it is considerably easier to prescribe severely addicting narcotics than it is to order home oxygen therapy"?
The Certification of Medical Necessity Form (HCFA form 484)
What were the findings of the study of Mason, et al. in their comparison of aerosol delivery via Circulaire system vs. conventional small volume nebulizer (Misty neb)?
The Circulaire had a smaller MMAD (0.51 vs. 1.45), greater lung deposition, reduced extrapulmonary deposition (by 5 fold), reduced amount of aerosol released into the environment (by 2 fold). There was no difference in penetration index or dead vol %.
We all know that when gas is allowed to escape from a high-pressure cylinder to the atmosphere, there is a cooling effect. What is this expansion cooling phenomenon called?
The Joule-Thompson effect
What is the difference between the Bird Mark 10 and the Mark 7?
The Mark 10 has no air/mix control (always in air dilution mode), it has an inspiratory flow accelerator (allows for an automatic increase in flow at the end of inspiration which compensates for leaks in the system)
Westgard proposed a set of rules for detecting real errors and rejecting fake errors when running arterial blood gas controls. What is this method called?
The Multiple-Rule Method
what is the unit of force in the SI system?
The Newton, which is the force required to give a free mass of 1 kg an acceleration of 1 meter per second per second
What are the differences in the inspiratory time percent control settings between the Servo 900B and the 900C?
The Servo 900B has a 15% setting, the Servo 900C has 67% and 80% setting and no 15% setting)
What is the difference between the Miller & Wisconsin laryngoscope blades?
The Wisconsin has a curve of slightly larger radius along longitudinal axis and is straight for it's entire length
What is relative humidity?
The absolute humidity in air (content) compared to water vapor capacity when saturated at a given temperature, expressed as a percentage (content/capacity x 100)
What is Venturi's principle?
The addition of a tube gradually increasing in diameter, not exceeding 15 degrees, in the direction of flow from the jet orifice will restore the lateral pressure of the gas toward prerestriction pressure
What 2 measurements are necessary for calculation of DLCO?
The amount of CO transferred, and the amount of CO passing from the alveoli to the blood each minute (measured by determining the difference of CO concentration in inspired and expired air)
Define diffusion coefficient.
The amount of a gas that will diffuse a distance of 1 um over a 1 cm2 area with a pressure gradient of 760 torr.
What is the relationship between the amount of drug nebulized by a small volume nebulizer and the amount of diluent used?
The amount of drug nebulized is increased as the diluent is increased (particle size decreases as flow rate increases)
How is dead volume of a small volume nebulizer determined?
The amount of drug solution remaining in the reservoir when the device begins to "sputter" and aerosolization ceases (35-60% of drug solution delivered; 53-72% delivered with vigorous agitation)
What is the major determining factor that determines home care costs?
The amount of skilled health care professional services
What does the phenomenon of cooperativity have to do with the function of a hemoglobin molecule?
The attachment of one molecule of oxygen to deoxygenated hemoglobin increases the affinity for subsequent oxygen molecules to hemoglobin - responsible for the sigmoid-shaped oxyhemoglobin dissociation curve
How does a catecholamine nucleus differ from a resorcinol?
The hydroxyl attachment at the #4 carbon is shifted to #5 carbon; metaproterenol (Metuprel, Alupent) and terbutaline (Brethine, Brethaine, Bricanyl) are both resorcinols
Define the term "pharmacognosy".
The identification of sources of drugs from plants and animals (or microbes)
What is the initial step in evaluating patients for pulmonary rehab.?
The interview
Other than the lungs, what two sites offer ideal conditions for the growth of tubercles following infection with Mycobacterium tuberculosis?
The kidneys, the ends of the long bones
According to Egan, during negative pressure ventilation, what determines the amount of gas that will expand the alveoli?
The magnitude of the transpulmonary pressure gradient (PL)
What is pH?
The negative log of the hydrogen ion concentration used as a positive number
What is Hopper's law?
The number of possible answers to any given RC question is directly proportional to the number of references consulted
What determines the atomic weight of an element?
The number of protons and neutrons in the nucleus
What phase of drug action describes the mechanisms of drug action by which a drug molecule causes its effect in the body?
The pharmacodynamic phase
What phase of drug action describes the time course and disposition of a drug in the body, based on its absorption, distribution, metabolism, and elimination?
The pharmacokinetic phase
What is critical pressure?
The pressure required to liquify a gas at its critical temperature
With regard to spirometers, what is meant by the term calibration?
The process by which the signal from a spirometer is adjusted to produce a known value
Where do high concentrations of ACP (acid phosphate) occur?
The prostate gland
Home health care is defined as what?
The provision of services and equipment to the patient in the home for the purpose of restoring and maintaining his or her maximal comfort, function, and health
What three factors determine the effectiveness of a buffer system?
The quantity of buffer available, the pK of the buffer system, and whether or not the buffer functions better in an open or closed system
Define diffusion.
The random molecular motion by which matter is transported from a region of higher concentration to one of lower concentration.
What is Fick's law?
The rate of transfer of a gas through a sheet of tissue is proportional to the tissue area and the difference in gas partial pressure between the two sides, and inversely proportional to the thickness of the tissue.
What is tonicity?
The relative degree of osmotic pressure exerted by a solution
If blood is placed in a vertical tube, the RBCs will tend to fall or "sediment" toward the bottom. A measurement of the speed at which they fall (distance per unit time) is known as what?
The sedimentation rate
State Hooke's law
The tension developed when an elastic structure is stretched is proportional to the degree of deformation produced
What does the term "pharmacokinetic" refer to?
The time course and disposition of a drug in the body
What is Dalton's law of partial pressures?
The total pressure of a gaseous mixture is equal to the sum of the partial pressures of the constituent gases. The partial pressure of each gas in the mixture is the pressure it would exert if it occupied the entire volume alone. The partial pressure exerted by each constituent gas is proportional to its volumetric percentage in the mixture.
The particle size of the aerosolized drug released from a MDI is determined by what two factors?
The vapor pressure of the propellant blend, diameter of the actuator opening
What are control variables?
The variables that the ventilator manipulates to accomplish inspiration (pressure, volume, flow, time)
What do SIP, SCL-90-R, POMS, KAS, MAALC, CES-S, STAI, PGWB, LSI, and MHLOC all have in common?
They are all assessment tools of psychological and behavioral functioning (SIP - sickness impact profile, SCL-90-R - Hopkins sickness checklist, POMS - profile of mood states, KAS - Katz activity scale, MAACL - multiple affect adjective check list, CES-D - center for epidemiology studies - depression inventory, STAI - state trait anxiety inventory, PGWB - psychologic general well-being scale, LSI - life satisfaction index, MHLOC - multidimensional health locus of control scale)
What do all of the following endotracheal tubes have in common: Gordon-Green, Bryce-Smith, Robert Smith, White, and Carlens?
They are all double lumen tubes
What is the mechanism of action of organophosphates such as parathion and malathion?
They are irreversible inhibitors of cholinesterase (military practice of carrying styrette of atropine was to counteract nerve gas agents of this type)
What is the advantage of using oxacillin or nafcillin in treating a staphlococcal pneumonia?
They are penicillinase-resistant
What is meant by the observation that oral Beta2-agonists undergo "first-pass" metabolism?
They are sulfated (removed metabolically) by enzymes in the intestine and liver (oral dose is 10-20 times the subcutaneous dose)
Describe the demonstration by Guedel & Waters at the 1928 AMA convention.
They demonstrated the value of adding a cuff to a tracheal tube by intubating a dog (named "Airway") and kept him anesthetized under water for several hours
When undergoing airway challenge testing, how long before the test should the patient refrain from taking corticosteroids?
They have little or no effect and do not need to he held (B2, anticholinergics, cromolyn - 24 hrs.; decongestants, antihistamines - 48 hrs.; hydroxyzine - 96 hrs.)
How much do cromolyn sodium particles increase in size when going from ambient to BTPS conditions?
They increase from 2.31 to 3.02 um AMMD
According to Egan, name two contraindications for PEEP.
Untreated bronchopleural fistula or pneumothorax, severe unilateral lung disease
What type of PEEP device is capable of maintaining a given pressure independent of flow?
Threshold resistor
What is the name of the nitrogenous base found only in DNA?
Thymine (Uracil is found only in RNA)
Accepted disability standards require all devices used to measure flow or volume to have time and volume scales of what minimum measurements?
Time - at least 20 mm/s, volume - at least 10 mm/L
The relationship between compliance and resistance of a lung unit can be quantified in a mathematical expression called what?
Time constant
What is the term used to describe a comparison of how rapidly a ventilator responds to patient demand?
Time delay
Once you have an estimate of REE for an individual, how should the total calories required be computed?
Total calories = REE x stress factor (for HBE - REE, use 1.5 - 1.7 for stress factor, for indirect calorimetry - REE, use 1.2 - 1.3 for stress factor)
What three lung capacities are reduced in idiopathic pulmonary fibrosis?
Total lung capacity, functional residual capacity, and vital capacity
What is the most common supernumerary anomaly of the lungs?
Trilobation of the left side (with accessory inferior lobe on either side)
What drug, other than pentamadine, is effective against P. carinii?
Trimethoprim-sulfamethoxazole
Before fetal hemoglobin, with its two alpha and two gamma chains, there is embryonic hemoglobin. What are the subunits of embryonic hemoglobin?
Two alpha and two epsilon chains (epsilon disappears at about 12 weeks of gestation)
Name the 3 types of bullae.
Type I - narrow necks, thin walls, empty interior; Type II - subpleural location, neck consists of pan acinar emphysematic lung tissue; Type III - broad necks, consist of slightly hyperinflated lung
The earliest changes in the lung during development of ARDS involved what cells?
Type I alveolar epithelial (95% of the lung surface area)
What are crocidolite, amonite, anthophyllite, and chrysolite?
Types of asbestos
What is a dyne?
Unit of force that when acting on a 1g mass gives to the mass an acceleration of 1cm/sec/sec. The dyne is the unit of force in the metric system.
With regards to the naming of drugs, what does USAN Council stand for?
United States Adopted Name Council
According to P & K, what is the main side effect besides increased breathlessness of Acetazolamide?
Unpleasant taste, especially when drinking carbonated beverages
For patients with severe pulmonary disease, what kinds of activities produce the most shortness of breath?
Unsupported upper extremity activities
During a He-dilution FRC test, how long is the test continued?
Until the He concentration is stable (less than 0.02% over 30 seconds) or at least 3 min
Which lobes of the lung are most commonly associated with bronchiectasis which is secondary to TB?
Upper lobes (basilar segments, particularly posterior are most common in general with right middle and lingula second)
Which is more sensitive for amylase, urine or blood?
Urine
What are 6 surgical procedures used to treat sleep apnea?
Uvulo-palato-pharyngoplasty (UPPP), nasal surgery, tonsillectomy, laser-assisted uvulo-palato-plasty (LAUP), maxillofacial surgery, tracheostomy
What does UPPP stand for?
Uvulopalatopharyngoplasty (first described by Fajita in 1981. Patients who most likely benefit are those with < 30 apneas/hr and those who don't exceed > 30% ideal body weight)
Of the mechanisms that produce hypoxemia, which is responsible for most of the defective gas exchange in pulmonary diseases?
V/Q mismatch
What is the most common mechanism of hypoxemia associated with idiopathic pulmonary fibrosis?
V/Q mismatch
In pneumonia, what are the two mechanisms by which hypoxemia are produced?
V/Q mismatch and shunting
How do you calculate the volume of disribution, VD?
VD = drug amt put into body divided by concentration of drug in blood (mg/mg/L)
In the classic study by Sahn and Lakshminarayan in 1973, a MIP below 20 cmH2O predicted weaning failure while a MIP above 30 cmH2O guaranteed weaning success. What other weaning parameters were evaluated in this study?
VE, MVV/VE (most post-op patients mean duration 37 hours, max duration 168 hours)
An important measure of the ventilatory response to exercise is the ventilatory equivalent. How is it calculated?
VE/VO2 (the amount of VE dedicated to any given metabolic rate; normal values = mid 20's (no units); higher numbers = increased ventilatory drive or increases VD/VT)
Name the two most likely candidates as the transmitter chemicals in the non-adrenergic, non-cholinergic fibers?
VIP (vasoactive intestinal peptide), PHM (peptide histidine methionine)
What do we call the point on a plot of oxygen consumption vs. work rate where the oxygen consumption no longer increases with work rate?
VO2 max
On the PB7200, the I:E ratio is a function of what parameters?
VT, rate, peak flow, and plateau settings
What do you call the strong mutual attractive forces which allow solids to maintain their shape?
Van der Waals forces
Within a solid, what do you call the attractive forces between adjacent molecules that limits the mobility of the molecules?
Van der Waals forces
What are phase variables?
Variables used by the ventilator to begin, sustain, and terminate each of the four phases (trigger - begins insp., limit - maintains at pre-set value during insp., cycle - terminates insp.)
What are 3 steps in the body's defense for preventing hemorrhage?
Vascular integrity (ability of vessel to constrict), formation of a platelet plug, formation of a fibrin clot
What is the effect of parasympathetic stimulation on pulmonary vasculature?
Vasodilation
What is the most common complication of fiberoptic bronchoscopy?
Vasovagal reaction (2.4%)
Transmission of a pathogen which occurs when a susceptible host is exposed to an infectious agent via contaminated food or water is known as what type of transmission?
Vehicle transmission
When using flowby on the PB7200, when does inspiration end during a spontaneous breath?
When exhaled gas flow exceeds the delivered flow by 2 L/min (this indicates that the patient-exhaled gas volume is contributing to the measured exhaled volume)
When does an elevated anion gap usually occur?
When fixed acids are produced (lactic acidosis) or added to the blood (poisoning)
When is the pressure support breath terminated on the PB7200?
When flow drops to 5 L/min or airway pressure rises above the pressure support level by 1.5 cmH2O
What determines that and atom is in an "ionized" state?
When one or more electrons are added to or removed from the outermost electron orbital
When performing and open-circuit nitrogen washout FRC determination, when is the test considered complete?
When the % nitrogen drops below 1% (less than 7 min. in normal individuals)
Under what conditions should the largest value, rather than the mean, be reported?
When the test is "effort dependent" ("best test" - largest result observed is based on the rationale that the subject cannot overshoot on a test that is effort dependent)
What are the most commonly used methods to measure sedimentation rate and how do they differ?
Wintrobe & Westergren, different tube size
What is Boyle's law?
With mass and temperature held constant, gas volume varies inversely with pressure
How long after the administration of dry gases via an endotracheal tube does damage to the tracheal epithelium occur?
Within 2 hours (gases at 60% RH produce no damage)
How long after a gastric secretion aspiration before the symptoms of dyspnea, tachypnea, cyanosis, and tachycardia develop?
Within 2 to 5 hours
In a pH electrode, there are two types of half-cells. What do you call each?
Working half-cell and reference half-cell
During High Frequency Oscillation, what do you call the number which quantifies the unsteadiness of oscillatory flow?
Wormersley Number
Is low HDL a risk factor for cardiovascular disease?
Yes
Acute infectious bronchitis is seen almost exclusively in what age group?
Young children 2 years or less
List 2 factors that increase the metabolism of theophylline by the liver.
Young children, smokers
What percent of the patient's receiving bitolterol develop muscle tremors?
about 15% (drug originally marketed as an MDI, a nebulizer solution has been released)
What is normal airway resistance during mouth breathing in the infant?
about 7 cmH2O/L/sec
What is the solubility of helium as compared to that of nitrogen?
about ½
Other than the heel, what two alternate sites may be used for capillary blood samples?
earlobe, tip of a finger
According to the ATS 1986 official statement, what exercise level of maximum VO2 is considered normal?
greater than or equal to 25 mL/kg/min (7.1METS); (less than severe = 15-25 mL/kg/min or 4.3-7.0 METS, severe < 15 mL/kg/min or 4.3 METS; METS = 3.5 mL/kg/min)
What is the use of hypotonic and hypertonic saline primarily indicated for?
inducing sputum specimens
List three of the side effects of succinylcholine which would be of concern to ICU patients receiving the drug?
muscle soreness from fasiculations, loss of intracellular potassium into the plasma (rise of plasma K+), increase in intraocular pressures, increase in intracranial pressures, can cause malignant hyperthermia
The results of a blood gas determination with the patient at a normal temperature of 37 degress C are pH = 7.40, PaCO2 = 40, and PaO2 = 95. What changes will occur if the temperature of the patient were 34 degress C?
pH = 7.44, PaCO2 = 35, PaO2 = 79 (at 40 degress C, pH = 7.36, PaCO2 = 46, PaO2 = 114)
At BTPS, what is the effect of metabolism on pH, PaCO2, & PaO2 per hour, and what is the change?
pH decreases by 0.05, PaCO2 increases by 5 mmHg, PaO2 decreases by 150 mmHg if initial PaO2 > 250 mmHg & by 20 if initial PaO2 < 150 mmHg
What is the accuracy of the sanz electrode?
plus or minus 0.02 pH units
What are the tolerance limits for an acceptable calibration of a 3 liter calibration syringe?
plus or minus 3% of known volume (2.91-3.09)
For spirometers, according to the ATS recommendations, what is the maximal acceptable error?
plus or minus 3% or 50 mL, whichever is larger
According to Egan, how accurate are pulse oximeters?
plus or minus 4% in normal hemoglobin saturation range
How are pressures expressed in psi converted to cmH2O?
psi x 70.34
