exam 2- respiratory

Define pulmonary embolism (PE) and identify the most common cause of PE. Identify three major S/S of PE and explain how these relate to the underlying pathophysiology of PE.

Pulmonary embolism (PE) is the blockage of an artery in the lungs that has moved from elsewhere (embolism). Characterized by SOB, chest pain, coughing up blood: decreased gas exchange; pain due to blockage and rupture of pulmonary vessels.

Define pulmonary fibrosis and explain the basic underlying pathophysiology.

Pulmonary fibrosis is scarring of the lungs over time, replacement of normal lung tissue with fibrotic tissue; results in stiffness and restrictive of lung volumes

The rate and depth of ventilation depends upon Select one: a. The central chemoreceptors, located in the carotid and aortic bodies. b. The peripheral chemoreceptors, located in the medulla. c. The central chemoreceptors, which are the major receptors that stimulate ventilation in response to carbon dioxide. d. The peripheral chemoreceptors, which are most sensitive to changes in carbon dioxide and are not responsive to oxygen levels.

The central chemoreceptors, which are the major receptors that stimulate ventilation in response to carbon dioxide.

What are major treatment approaches to PE? Specifically explain the rationale for anticoagulation and thrombolytic approaches to PE

Tx: anticoagulants (prevent: heparin) and thrombolytic (attack already formed clot: tPA)

Asthma would best be classified as which type of respiratory disorder? obstructive or restrictive

obstructive

Which of the following conditions best describes primary atelectasis? Select one: a. A baby is born prematurely and lacks surfactant. b. A man suffers from an airway obstruction caused by a mucus plug. c. A woman suffers from a pneumothorax caused by a traumatic accident. d. A man is in a car accident and suffers a vascular injury that results in a pleural effusion.

A baby is born prematurely and lacks surfactant.

Which of the following respiratory structures would be found in the respiratory zone? Select one: a. Mucocilliary escalator b. Trachea c. Bronchi d. Alveoli

Alveoli

Kayla suffers from interstitial lung disease. When you look at her fingers you notice that they are deformed, appearing enlarged and bulging (bulbous). This physical sign related to her respiratory disease would best be classified as which one of the following signs? A.Dyspnea B.Cyanosis C.Clubbing D.Chronic cough

C.Clubbing

Restrictive lung disorders are best characterized by which one of the following? A.Decreased airway resistance B.Decreased compliance C.Decreased lung volumes D.Decreased forced expiratory volume in one second (FEV1)

C.Decreased lung volumes

Which one of the following disorders would have increased compliance? A.Pulmonary fibrosis B.Pulmonary edema C.Emphysema D.Pneumonia

C.Emphysema

Define COPD and explain how bronchitis and emphysema contribute to this condition?

COPD is a progressive obstructive respiratory disease characterized by SOB, cough, sputum production; older terms: chronic bronchitis (inflammation of bronchi) and emphysema (air trapping) contribute to COPD.

Pleural effusion characterized by transudate (fluid) in the pleural space

Hydrothorax

What is/are the pulmonary function testing indicators of a restrictive respiratory disorder?

Decreased lung volumes: tidal volume, vital capacity

Define DVT and explain how this relates to PE. What are the specific risk factors in our patient for DVT?

Deep vein thrombosis (DVT) is common source of embolism; overweight, sedentary, smoker, BCPs (estrogen).

Which of the following scenarios best describes a condition where the amount of dead space is increased? Select one: a. A woman with pneumonia and mucous plugs b. A man with a blood clot that embolizes to the lungs c. A child suffering from bronchoconstriction d. An elderly man that has pulmonary edema

A man with a blood clot that embolizes to the lungs

Which of the following statements about ventilation—perfusion matching is correct? Select one: a. Generally, both ventilation and perfusion are matched across the lungs with the lower portions of the lungs receiving less ventilation and perfusion, on average. b. Blockage of an alveolus because of a mucous plug would increase dead space. c. Blockage of a capillary because of an embolism would increase the shunt fraction. d. A person with pulmonary edema would likely have an increase in the shunt fraction, which could lead to hypoxemia.

A person with pulmonary edema would likely have an increase in the shunt fraction, which could lead to hypoxemia.

Obstructive lung disorders are best characterized by which one of the following? A.Increased airway resistance B.Increased compliance C.Increased lung volumes D.Increased forced expiratory volume in one second (FEV1

A.Increased airway resistance

Which one of the following conditions would most likely increase pulmonary shunt? A.Emphysema B.Pulmonary embolism C.Atelectasis D.Pulmonary hypotension

C.Atelectasis

Which of the following disorders best describes a condition characterized by acute lung inflammation and diffuse injury to the alveolocapillary membrane? Select one: a. Acute respiratory distress syndrome b. Asthma c. Bronchitis d. Emphysema

Acute respiratory distress syndrome

Which of the following statements about asthma is NOT CORRECT? Select one: a. Asthma is primarily a restrictive respiratory disorder. b. Decreased TLC is characteristic of a restrictive disorder. c. In asthma, the FEV1/FVC ratio may be decreased from normal. d. Asthma may be characterized by a hyperinflation of the lungs, which is reflected as an increase in residual volume.

Asthma is primarily a restrictive respiratory disorder.

Identify three disorders that are obstructive airway disorders.

Asthma, Bronchitis, Emphysema, COPD

Kerry has abnormal enlargement of the right side of her heart secondary to pulmonary hypertension. Most likely Kerry would be suffering from which one of the following pulmonary disorders? A.Pulmonary embolism B.Cor pulmonale C.Acute respiratory failure D.Acute respiratory distress syndrome

B.Cor pulmonale

Kyle is a chronic smoker who experienced a pneumothorax resulting from internal blistering on his lung surface which allowed air to enter his pleural space. He has no other respiratory disease. Kyle would most likely be suffering from which one of the following types of pneumothorax? A.Tension pneumothorax B.Primary pneumothorax C.Secondary pneumothorax D.Traumatic pneumothorax

B.Primary pneumothorax

Kathy is experiencing congestive heart failure and has a breathing pattern that involves a waxing and waning tidal volume with periodic apnea. This breathing pattern would best be described by which one of the following terms? A.Dyspnea B.Tachypnea C.Cheyne-Stokes respiration D.Kussmaul respiration

Cheyne-Stokes respiration

Jane had a chest infection and was feeling short of breath, experiencing a sharp pain in her chest. Her nurse practitioner detected diminished breath sounds and chest x-ray revealed that Jane was suffering from a pleural effusion. Thoracentesis (a pleural tap) was performed to remove a sample of the fluid causing the effusion, and lymph was detected. Based upon this information, Jane is most likely suffering from a(n): Select one: a. Hydrothorax b. Empyema c. Hemothorax d. Chylothorax

Chylothorax

Pleural effusion characterized by lymphatic fluid in the pleural space

Chylothorax

What happens to compliance in a restrictive lung disorder?

Compliance is decreased, and this is an important indicator of a restrictive disorder

Define compliance. What has happened to her compliance?

Compliance is stretch under pressure; compliance is decreased in pulmonary fibrosis

Why are his nail beds blue? Why does he have edema?

Cyanosis: bluish discoloration from inadequate oxygenation of blood; complication of COPD of pulmonary hypertension can give rise to cor pulmonale and lead to swelling; this is due to narrowing of blood vessels and destruction of blood vessels around the alveoli that can lead

Kirk is suffering from a fulminate form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury. Kirk is most likely suffering from which one of the following pulmonary disorders? A.Pulmonary embolism B.Cor pulmonale C.Acute respiratory failure D.Acute respiratory distress syndrome

D.Acute respiratory distress syndrome

What are the major diagnostic approaches to PE? Specifically identify the various blood tests and diagnostic imaging tests that are useful for diagnostic purposes.

Dx:D-dimer; angiography; V/Q scan

The subjective sensation of not being able to get sufficient air is best described by which of the following terms? Select one: a. Dyspnea b. Eupnea c. Tachypnea d. Apnea

Dyspnea

Which of the following would most likely be associated with an increase in lung compliance? Select one: a. Pulmonary fibrosis b. Pulmonary edema c. Emphysema d. Pneumonia

Emphysema

An abnormal collection of exudate in the pleural cavity that forms during an infection or as a consequence of an autoimmune disorder such as lupus, would be classified as which of the following types of pleural effusion? Select one: a. Hydrothorax b. Empyema c. Hemothorax d. Chylothorax

Empyema

Pleural effusion characterized by a collection of pus in the pleural space

Empyema

Why does the bronchodilator exaggerate the tachycardia? A beta2-adrenergic agent was prescribed for further use. Based on your knowledge of beta1 and beta2 receptors why might this be a good suggestion? An anticholinergic agent was also suggested as a possible nebulizer agent. How might this help the breathing problem? How would anti-inflammatory agents like glucocorticoids benefit your patient?

Epinephrine is a non-specific beta adrenergic agonist that can relax airway smooth muscle, but activates the beta1 (cardiovascular, tachycardia) and beta2 (bronchial smooth muscle); anticholinergics relax airways and can reduce mucus production; anti-inflammatory drugs help with inflammation that underpins asthma.

Why is expiration more difficult than inspiration in this person? What causes the hypoxemia and the hypocapnia in this person?

Expiration is normally passive, but with reduces airway radius, one must work to get out the air; hypoxemia due to impaired gas exchange; hypocapnia due to increased RR (hyperventilation).

What is/are the best pulmonary function testing indicators of an obstructive respiratory disorder?

FEV1 and FVC; FEV1/FVC ratio reduced in obstructive lung disorders

Pleural effusion characterized by blood in the pleural space

Hemothorax

Which of the following statements about asthma is NOT CORRECT? Increased airway resistance is characteristic of asthma. Asthma may be associated with symptoms such as coughing, wheezing, shortness of breath, or chest tightness. Asthma may be characterized by a hyperinflation of the lungs, which is reflected as an increase in residual volume. In asthma, the FEV1/FVC ratio may be increased from normal.

In asthma, the FEV1/FVC ratio may be increased from normal.

Which of the following variables is primarily altered in a person that suffers from pulmonary fibrosis? Select one: a. Increase the thickness of the respiratory membrane b. Decrease the surface area for gas exchange c. Decrease in the concentration gradient for oxygen across the respiratory membrane d. Increase in the diffusion constant for carbon dioxide across the respiratory membrane

Increase the thickness of the respiratory membrane

Which of the following best describes an obstructive lung disorder? Pulmonary edema Decreased compliance Increased airway resistance Pulmonary fibrosis

Increased airway resistance

Which of the following best describes an obstructive lung disorder? Select one: a. Decreased compliance b. Pulmonary Fibrosis c. Pulmonary Edema d. Increased airway resistance

Increased airway resistance

A breathing pattern associated with metabolic acidosis that might be observed in a patient with diabetic ketoacidosis would be: Select one: a. Tachypnea b. Dyspnea c. Cheyne-stokes respiration d. Kussmaul respiration

Kussmaul respiration

.Define asthma and list its characteristics. Is asthma primarily a restrictive or an obstructive disorder. Defend your answer with laboratory and pulmonary function test results.

Long-term inflammatory disease that leads to airway obstruction; obstructive; FEV1, peak expiratory flow rate.

Our patient with COPD has a "prolonged expiratory phase" to his respirations. In the case of emphysema what is the most likely mechanism that underlies this slowing of forced expiration? Select one: a. Increased airway resistance due to mucous b. Loss of elastic recoil of the lungs c. Increased airway resistance due to inflammation d. Smooth muscle constriction of the airways

Loss of elastic recoil of the lungs

What is the pathophysiology underpinning pneumothorax and its consequence on respiratory function? What is the difference between a closed and an open pneumothorax and how do these terms relate to primary and secondary spontaneous pneumothorax?

Loss of negative pressure = collapse of lung; open = open to outside; closed = closed to outside; primary/secondary spontaneous = typically closed.

What is the significance of her low PaO2 and O2 sat? What about her slightly less than normal PaCO2? Why did her oxygen levels change dramatically, but not her carbon dioxide levels during exercise?

Low PaO2 and O2 sat indicate compromise to gas exchange (increase X); low PaCO2 suggests easier to exchange CO2; greatest compromise is to getting oxygen across when the gas exchange time is reduced with increased blood pressure/flow during exercise.

How does loss of negative pressure in the pleural space result in a collapsed lung? What does the unequal chest rise; minimal movement; diminished breath sounds tell you about the pneumothorax? Although not in our patient, tracheal deviation can occur on which side (injured or non-injured)?

Negative pressure in pleural space creates a vacuum that holds open the lung...when this is lost due to air entering this can lead to the collapse of the lung. One side of chest cavity has increased pressure (rises) and trachea will deviate toward the opposing side. Diminished breath sounds on side of collapse.

How do his airway changes and changes in lung elasticity explain his PFT results? Why is Al's AP chest diameter increased and how does this correspond to the PFTs?

PFT results: decreased VC (obstruction of airways), increased RV and FRC (air trapping); Barrel chest: increase thoracic volume due to hyperinflation of lungs

Why does he have an increased PaCO2 and what would you guess about his Acid-Base status?

PaCO2 increased (69 vs. 40 mmHg); respiratory acidosis [bicarb of 34 mEq (N = 24 mEq/L), suggests compensation for acidosis]

Why are PaO2 and O2 saturation levels decreased? What does expiratory flow refer to and why is it decreased in Al?

PaO2 decreased (48 vs. 100 mmHg); O2 saturation decreased (78 vs. 100%): decreased gas exchange

Explain the major S/S: pleuritic pain, increased RR, dyspnea, chest asymmetry, and hypoxemia. What is the rationale of the following treatment approaches: oxygen, pain medication chest tube?

Pain (obstruction/inflammation/hypoxia); increased RR/dyspnea (hypoxia); chest asymmetry (different pressure on either side); hypoxemia (decreased gas exchange). Oxygen (maximize gas exchange), pain medication (treat pain), chest tube (evacuate air to re-establish vacuum and open lung).

Which of the following statements about Pulmonary Fibrosis is NOT CORRECT? Select one: a. Persons with pulmonary fibrosis have an increased total lung capacity (TLC). b. Pulmonary fibrosis may be associated with an inflammatory process that leads to an increase in scar tissue. c. Reduced PaO2 levels are due to impaired gas exchange. d. Decreased PaCO2 levels may be a consequence of hyperventilation.

Persons with pulmonary fibrosis have an increased total lung capacity (TLC).

Define pneumothorax and explain the major underlying causes/risk factors for a primary spontaneous; a secondary spontaneous; or a traumatic pneumothorax. What is a tension pneumothorax and why is this a life-threatening condition?

Pneumothorax:abnormal collection of air; primary (smoking); secondary (COPD); traumatic (open: stab wound; closed: blunt trauma); tension (under pressure; air can't escape); crushes lung/heart.

Failure of the lungs to expand at birth

Primary Atelectasis

Identify three disorders that are restrictive airway disorders.

Pulmonary Fibrosis, Pulmonary Edema, Pneumonia

A pulmonary vascular disease characterized by occlusion of blood flow because of a thrombus, lipids, or air bubble is best described as: Select one: a. Pulmonary hypertension b. Pulmonary embolism c. Cor pulmonale d. Acute Respiratory Distress Syndrome

Pulmonary embolism

Define restrictive and obstructive respiratory disorders. What type of disorder (restrictive or obstructive) is pulmonary fibrosis? How did you make this determination?

Restrictive: decreased compliance/lung volumes; obstructive: increased airway resistance: evidence of decreased lung volumes

Partial or total collapse of a lung or a segment of a lung that was once expanded

Secondary Atelectasis

Jason smoked a considerable amount in college. One day, he experienced sharp chest pain and could not catch his breath. His roommate took him to the emergency room, where he was diagnosed with a collapse lung. Based upon the above information, Jason's condition would most likely be described as a Select one: a. Tension pneumothorax b. Secondary pneumothorax c. Spontaneous pneumothorax d. Traumatic pneumothorax

Spontaneous pneumothorax

.The formula for determining residual volume (RV) is: TLC = RV + VC. Determine the RV before and after the use of the bronchodilator. What does the change in pulmonary function after the bronchodilator therapy indicate?

TLC = RV + VC; BEFORE: TLC-VC = RV; 6.82L-2.9L = 3.92L; AFTER: 5.96L-4.15L = 1.81L; bronchodilation opens airways and reduces residual volume

Explain how shock occur with a tension pneumothorax. How would you classify this type of shock?

Tension pneumothorax crushes heart and prevents filling...OBSTRUCTIVE shock.

Define TLC, FRC and RV and explain why her TLC, FRC, and RV values decreased? Define FEV1 and FVC and explain why her FEV1/FVC is increased.

Total Lung Capacity; Functional Reserve Capacity; Residual Volume; all lung volumes reduced; Forced Expiratory Volume in one second; functional vital capacity; no problem with airway, but FVC is reduced so ratio can increase.

Which of the following statements about asthma is correct? Increased airway resistance would result from an increase in airway radius. Anti-inflammatory agents like a glucocorticoid would not be beneficial to a patient with asthma, since asthma is a disorder that is not associated with inflammation. V/Q mismatching in asthma would generally be characterized as an increase in the shunt fraction A beta-agonist would promote bronchoconstriction and thus would reduce airway resistance.

V/Q mismatching in asthma would generally be characterized as an increase in the shunt fraction

Which of the following statements about asthma is CORRECT? Select one: a. Increased airway resistance would result from an increase in airway radius. b. A beta-agonist would promote bronchoconstriction thus would reduce airway resistance. c. V/Q mismatching in asthma would generally be characterized as an increase in the shunt fraction. d. Anti-inflammatory agents like a glucocorticoid would not be beneficial to a patient with asthma, since asthma is not an inflammatory disorder.

V/Q mismatching in asthma would generally be characterized as an increase in the shunt fraction.

What is Virchow's triad and how does this relate to risk of DVT?

Virchow's triad: 2 of 3 (or more) puts patient at risk of DVT: (1) venous stasis; (2) hypercoagulability; (3) endothelial injury

In pulmonary function testing, you might ask your patient to fill their lungs as much as possible, then to blow out as much air as they can. The amount of air they would expire (from a maximal inspiration to a maximal expiration) is called the Select one: a. Total lung capacity b. Vital capacity c. Residual volume d. Functional residual capacity

Vital capacity

Which of the following may be a trigger for an asthma attack? exposure to cold exposure to allergens exposure to second hand smoke all of the above

all of the above

Which of the following is NOT associated with the development of atelectasis? Select one: a. an increased production of surfactant b. airway obstruction by a mucous plug c. ineffective cough reflex d. anesthesia from surgery that promotes accumulation of bronchial secretions

an increased production of surfactant

Restrictive disorders Select one: a. are characterized by an increased compliance. b. are characterized by a reduced forced expiratory volume of one second (FEV1). c. are characterized by decreased lung volumes such as vital capacity. d. include chronic bronchitis.

are characterized by decreased lung volumes such as vital capacity.

Pleural effusions may result from Select one: a. increased capillary hydrostatic pressure b. decreased capillary permeability c. increased colloidal osmotic pressure d. decreased pressure in the lymphatic system

increased capillary hydrostatic pressure

dead space

ex: pulmonary embolism, cardiovascular shock

Hypocapnia occurs as a consequence of hypoventilation, which reduces CO2 levels. true or false

false

Define FEV1. What is the relationship between FEV1 and obstructive lung disorders?

forced expiratory volume in one second (FEV1), airway resistance (reduced radius) leads to obstruction of airflow.

In ventilation and perfusion mismatching Select one: a. impaired ventilation leads to increases in dead space b. impaired perfusion leads to increases in the shunt fraction c. hypoxia rather than hypercapnia is characteristic, unless mismatching is severe d. increasing the inspired oxygen fraction will improve hypercapnia, but not hypoxia

hypoxia rather than hypercapnia is characteristic, unless mismatching is severe

Medicine for asthma may include bronchodilators that relax smooth muscle to help open up the airways. true or false

true

Pulmonary vascular diseases include Select one: a. pulmonary embolism, where blood flow to the lungs are increased b. pulmonary hypertension, where increased hydrostatic pressure can lead to pulmonary edema c. cor pulmonale, characterized by enlargement of the left ventricle of the heart d. pulmonary edema, where decreased capillary permeability leads to fluid collection in the lungs

pulmonary hypertension, where increased hydrostatic pressure can lead to pulmonary edema

The forced expiratory volume in one second (FEV1) is often reduced in an obstructive lung disorder like asthma because of increased airway resistance to expiratory flow. true or false

true

Which parameter of Poiseuille's Law is most likely to contribute to an obstructive disorder?

r = radius: R = 8ƞl/𝛑r4

shunt

refers to the idea that there is no ventilation ex: atelectasis, pneumonia, mucus plug

high c02 in our patient with copd

respiratory acidosis with decreased ventilation with co2 = acid

The most important variable governing airway resistance is the radius of the airway. true or false

true

A condition called atopic dermatitis involves the association of skin inflammation with asthma or hay fever.

true

Kevin is suffering from pulmonary fibrosis. Which one of the following parameters of Fick's Law of Diffusion is most likely compromised in a person with pulmonary fibrosis? A.D B.A C.C D.X

x