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RES 222
RES 222- Adult pathophysio
| Question | Answer |
|---|---|
| In fungal diseases of the lung, tactile, and vocal fremitus would more than likely be decreased | FALSE |
| Which of the following are clinical manisfestations that may be associated with TB | Dull precussion note, bronchial breath sounds, radiographic evidence of cavity formation |
| Clinical findings associated with lung abscess are | Decreased FEVT and Foul smelling brown or gray sputum |
| When lung abscess is caused by methicillin-suseptible strains of Staph aureus, nafcillin or oxacillin may be used to treat it | TRUE |
| In the wet drowning victim a normal chest radiograph in the first 24 hours rules out the possiblity of alveolar-capiliary deterioration | FALSE |
| A positive tuberculin test begins with a wheal of what size | 10mm or greater |
| In wet drowning, when fluid is initially inhaled, the bronchi ___________ in response to a _____________ reflex. | constrict, parasympathetic-mediated |
| When a pulmonary embolus lodges itself in the pulmonary circulation there is an increase in blood flow distal to the obstruction1 | FALSE |
| Which of the following is by far the most common source of pulmonary embolism | Blood clot |
| Pulmonary edema is considered an obstructive pulmonary disorder | False |
| All of following are considered major pathologic or structual changes associated with pulmonary edema | frothy pink secretions throughout the tracheobroncial tree, alveolar atelectasis and intersitial edema |
| Because no carbon dioxide or oxygen exchange occurs beyond a pulmonary embolus, dead space and wasted ventilation increases | TRUE |
| _______________ refers to infection from bacilli that escape from a tubercle and move to sites other than the lungs | Disseminated tuberculosis and extrapulmonary tuberculosis |
| Major pathologic and structual changes occuring with wet drowning include | frothy white and pink secretions t/o the tracheobroncial tree, intersitial edema, larngospasm and bronchospasm |
| TB bacilli are almost exculsively transmitted within aerosol droplets, produced by the coughing, sneezing, or laughing of an individual with active TB | True |
| Graduated compression stockings used to prevent pulmonary embolism, help the veins and muscles move more blood more efficiently by squeezing the patient's arm | false |
| What happens to alveolar surface tension in pulmonary edema | it increases |
| which of the following may be pathologic or structual changes to the lungs associated with pulmonary embolism | alveolar atelectasis, pulmonary infarction, blockage of the pulmonary vascular system, possible release of cellular mediators leading to bronchoconstriction |
| When a drowning victim with fixed and dilated pupils has been submerged in cold water for 30 minutes the prognosis is always poor. true or false? | false |
| Which of the following are clinical findings associated with pulmonary embolism | Increased density in infracted areas on radiograph, increased pulmonary artery pressure, decreased DO2 |
| In QFT-G testing an elevated IFN-gamma level is diagnostic of TB, true or false? | TRUE |
| Echinocandins is a relatively new class of antifungal agnets used to treat fungal infections from Aspergillus and Candida, True or False? | TRUE |
| When is it necessary to intubate and mechanically ventilate a drowning victim? | The patient is not breathing spontaneously or The patient is breathing spontaneously with a PaO2 <60 mmHg on an FIO2 0.40 |
| Which of the following is the most common fungal infection in the United States? | Histoplasmosis |
| Apena associated with near wet drowning is directly related to the length of time the victim is submerged (i.e. the longer the submersion the more likely the victim is w/o spontaneous respirations) | TRUE |
| Pulmonary angiography is an extremly accurate test for determining the presence of pulmonary embolism? true or false | TRUE |
| Chest assessment findings commonly show which of the following directly over a lung abscess? | pleural friction rub, dull percussion note, bronchial breath sounds, dimished breath sounds |
| The most commonlyu used tuberculin skin test is the | Mantoux test |
| Colloid osmotic pressure is called oncotic pressure | TRUE |
| Which of the following is/are considered first-line agent(s) of tuberculosis for the entire 9 month protocol | Isoniazid and Rifampid |
| H Capsulatum is commonly found in the soil that is near chicken houses, pigeon lofts, and barns | TRUE |
| The chest radiograph for lung abscess will more than likely show decreased opacity, cavity formation and pleural effusion | FALSE |
| A necrosis of lung tissue that, in severe cases leads to a localized air and fluid-filled cavity is the definition of | Lung Abscess |
| During treatment the victim's body temperature may be increased using which of the following | IV administration of heat solutions, heated lavage to peritoneal spaces, heating blankets, heating the victim's inspired air |
| During wet drowning cardiogenic pulmonary edema results from fluid in the pulmonary capillaries moving into the perivascular spaces | FALSE |
| Vancomycin is commonly used to treat methcillin-resistant strains of S Aureus | TRUE |
| What is considered tthe most common cause of pulmonary edema? | increased capillary hydrostatic pressure |
| Risk factors associated with causing pulmonary embolism realted to venous stasis include | Inactivity/prolong sitting, Excesive hip or abdominal operations |
| which of the following fungal infections are considered opportunistic pathogens seen in patients with HIV infection | Cryptococcus and Aspergillius |
| Which of the following are considered common causes of cardiogenic pulmonary | Excessive fluid administration, left ventricle failure, and mitral valve disease |
| Which of the following is considered a thrombolytic agent used in treating pulmonary embolism | Streptokinase |
| Which of the following are clinical findings that may be associated with pulmonary edema | Decreased pH and increased PaCO2 in severe edema, Decreased cardio outout, Increased shunting |
| At onset, those portions of the lungs affected by pulmonary embolism will have a _______ | High V/Q ratio |
| Medications and procedures used to help manage pulmonary edema include | Positive inotropic agents, diuretic agents, ACE inhibitors |
| The following are pathologic or structural changes associated with lung abscess | Atelectasis, cavity formation, tissue necrosis, fibrosis and calcification of the lung parenchyma |
| Which of the following anatomic alterations of the lungs are associated with lung abscess | Cavity formation, alveolar consolidation, Bronchopleural fistula, Atelectasis, excessive airway secretions |
| Which of the following should be done when treating a near drowning victim during transport? | Administer the highest quality CPR possible, Conserve the victim's body heat, Administer 100% oxygen |
| Which of the following are clinical findings in near wet drowning victim | Tachypnea, Decreased lung compliance, An increase in intra-pulmonary shunting |
| What is the normal hydrostatic pressure in the pulmonary capillaries that tends to move fluid out of the pulmonary capillaries | 10-15 mm Hg |
| Which of the following factors favor a positive prognosis in cold-water near drowning?? | The colder the water the better |
| The different types of drowing include: | Wet drowning, near drowing, dry drowning |
| After being inhaled, fungal spores may reach the lungs where ________ and ________ engulf them. | Macrophages and Polymorphonuclear leukocytes |
| Coccidioidmycosis is also known as | Desert fever |
| Which of the following is considered the drug of choice for most fungal infections? | IV Amphotercin B |
| Predisposing factors that frequently lead to the aspiration of gastrointestinal fluids (and anaerobes) are usually related to which of the following? | General anesthesia, head trauma, cerebrovascular accident, seizure disorder, alcoholic abuse |
| Coughing and hemoptysis due to a pulmonary embolism can be the result of | plasma moving across the alveolar capillary membrane into the alveolar spaces, increased pulmonary hydrostatic pressure, red blood cells moving across the alveolar capillary membrane |
| Which of the following may be implicated in causing ILD? | Berylliosis, Silicosis, Goodpasture's syndrome, Coal dust, and Radiation therapy |
| Is pneumonthorax considered an obstructive disorder? | NO |
| Kyphosis is a | posterior curve of the spine |
| The main goal of managing interstitial lung disease is directed at controlling the inflammation associated with the various disorders | TRUE |
| What term is used to describe the accumulation of gas (free air) in the pleural space | Pneumothorax |
| In the most severe cases a chest tube is commonly used to treat a pneumothorax. since air rises the tube is normally placed posteriorly near the base of the lung | FALSE |
| Squamous cell carcinoma | originates from the basal cells of the bronchial epithelium |
| Surgical resection is usually an option for patients with NSCLC up to stage IIIA | TRUE |
| In patients suffering from kyphoscoliosis oxygen therpay is used to; treat hypoxemia, decrease the work of breathing and decrease myocardial work. Hypoxemia caused by capillary shunting is often refractory to oxygen therapy | TRUE |
| Which of the following are considered major pathological or structural changes associated with pleural effusion | Compression of the great veins, Atelectasis, Decrease venous return of blood to the heart, lung compression |
| NONE of the following are clinical manifestations below that are normally assoicated with kyposcoliosis | Decreased heart size seen on chest radiograph due to cor pulmonale, Increased FVC, Decreased pulmonary shunting, Hyperinflated areas seen on chest radiograph where lung compression is evident, decreased CVP and PA |
| Polycythemia and cor pulmonale are both late findings associated with kyphoscoliosis | True |
| During the chronic stages of ILD the inflammatory state is charcterized by edema and the infiltration of a variety of RBCs in the alveolar walls | FALSE |
| NONE of the of the following are considered clinical findings associated with pneumothorax | Decreased VC, Decreased FRC, Increased CVP, and Decreased cardio output |
| Which of the following can be used in managing/ treating pleural effusion | Chest tube drainage, pleurodesis, Hyperinflatio protocol, Thoracentesis, Oxygen therapy protocol |
| When gas (free air) enters the pleural space the visceral and parietal pleura bond together | FALSE |
| Which of the following are also used to describe interstitial lung disease | Pulmonary fibrosis and Pneumoconiosis |
| Because acute changes superimposed on chronic ventilatory failure are rarely seen in the patient with ILD the use of mechanical ventilation is never required | FALSE |
| A mediastinal shift to the unaffected side may be associated with a pleural effusion | TRUE |
| The following are considered major pathologic or structural changes associated with ILD | Cavity formation, Honeycombing, and Bronchospasm |
| Identify the clinical manifestations that may be assciated with pleural effusion | Increased pulmonary shunting, Increased CVP and Increased PVR, Blunting of the costophrenic angles and the pressence of a meniscus sign on chest radiograph, depressed diaphragm |
| A pnumothorax that is the result of a specific diagnostic or therapeutic procedure is referred to as a traumatic pneumothorax | FALSE |
| Fail chest is considered a obstructive pulmonary disorder | False |
| Trauma to the neck commonly causes which of the following | Chylothorax |
| Systemic lupus erythematosus presents as a multisystem disorder mainly involving the skin and joints. However, the lungs are involved in about _______ of the cases | 50% to 70% |
| Surgery is normally the best option for those patients who have NSCLC in both lungs up to an including stage IV disease | FALSE |
| Thoracentesis may be useful both therapeutically and diagnostically in the management of pleural effusion | TRUE |
| Systemic diseases associated with ILD include | Scleroderma |
| Which of the following are considered causes of flail chest? | Motor vehicle accident, Industrial accident, Direct compression by a heavy object |
| What value is used as a benchmark for not being able to view a pleural effusion on an upright chest x-ray? | when the effusion is less than 300ml |
| The hypoxemia associated ILD is normally caused by | Capillary shunting,Alveolar thickening, fibrosis |
| What type of radiographic technique should be used when a pleural effusion is difficult to determine because of the obliteration to one or both diaphragms by atelectasis and or pulmonary infiltrates | Lateral decubitus view |
| Which of the following describes ILD | It can be both a restrictive and an obstructive disorder |
| The clinical manifestations associated with Kyphoscoliosis are based on the clinical scenarios activated by which of the following | Excessive bronchial secertions and Atelectasis |
| Which of the following seem to be possible causes of Kyposcoliosis | Neuromuscular disorders, Hormonal imbalance, Tumors, Bone infections |
| A disorder where there are double fractures of at least three or more adjacent ribs causing the thoracic cage to become unstable is specifically referred to as____________ | A Flail chest |
| The presence of blood in the pleural space is best known as _________ and can be confirmed by checking___________ | Hemothorax, Hematocrit |
| The most common cause of plerual effusion is | congestive heart failure |
| In a patient with a pneumothorax when is the evacuation of air from the pleural cavity usually necessary | When it is larger than 20% |
| Microscopic examiniation of the thickened septa in asbestosis reveals | brown or orange baton-like structures |
| What type of breath sounds are produced by a pneumothorax | Decreased breath sounds |
| An increased respiratory rate seen in patient's with kyposcoliosis may be the result of which pathophysiologic mechanisms? | Decreased lung compliance/increased respiratory rate relationship, Stimulation of perpheral chemoreceptors, pain/anxiety, Hypoxemia |
| What is the term specifically used to describe a pneumothorax that results in a one-way valve allowing gas to enter the pleural space on inspiration but prohibiting it from leaving on expiration | tension/ closed pneumothorax |
| In order to evacuate air from the pleural cavity and re-expand a lung affected by a pneumothorax, the suction should | not exceed -12cmH2O |
| Major causes of a transudative pleural effusion include | Hepatic cirrhosis, Pulmonary embolus, Neprhrotic Syndorme |
| Which type of lung cancer is most associated with cigarette smoking and carries with it the worst prognosis | Oat-cell carcinoma |
| Treatment/management options for those patients with small-cell lung cancer usually include: | Supportive care, Chemotherapy, Radiation therapy |
| Which of the following is/are non-small-cell lung cancers | Squamous carcinoma, Adenocarinoma |
| Which of the following may be associated with Kyphoscoliosis? | Rhonchi, Dull percussion note, Bronchial breath sounds |
| A spontaneous pneumothorax is secondary to which of the following disorders | COPD, TB, Pneumonia |
| Respiratory care treatment options for the patient diagnosised with Lung CA include: | O2 therapy, Aersolized medication protocol, Bronchopulmonary hygiene, Lung expansion therapy |
| Common surgical procedures suggested for the patient with NSCLC include: | Lobectomy, pneumonectomy, wedge resection |
| Large cell carcinoma | is an undifferntiated form of lung cancer |
| Fill in the blanks: In severe cases of pneumonthorax the great veins can become _______ and cause ________ return to the heart to the heart to__________. | Compressed, venous, diminished |
| Which of the following are considered major pathological or structural changes associated with bronchogenic carcinoma | Airway obstruction from blood, mucus accumulation or a tumor projecting into a bronchus, Atelectasis, Pleural effusion, and cavity formation |
| Which of the following may be considered small-cell lung cancers | Oat-cell carcinoma |
| Major pathological or structural changes of the lungs associated with Kyphoscoliosis include | Mediastinal shift, Atelectasis, Lung compression due to thoracic deformity |
| Select the statements below that describe the TNM classification system | The letter " N" in the TMN system represents lymph node involvement, The letter "M" in the TMN system denotes the extent of metastasis, Roman numerals assist in identifying the different stages of cancer with " IV" indicating the most advanced stage |
| Select the clinical manifestations that can be associated with ILD: | Decreased PEFR, Pitting edema and distended neck veins, Increased pulmonary shunting, CXR exhibiting cavity formation, granulomas and/or bilateral reticulonodular appearance |
| which of the following are used to managed/ treat flail chest | Routine bronchial hygiene, Oxygen therapy protocol, Medication for pain management, volume controlled ventilation with PEEP to stalize the flail |
| Which of the following normally help to determine the prognosis for a victim of a fire | Age of the victim, Duration and extent of smoke exposure, chemical composition of the smoke being inhaled |
| the cause of Myasthenia Gravis appears to be related to circulating antibodies that disrupt the transmission of acetylcholine | TRUE |
| What is the therapeutic goal of low tidal volume ventilation in ARDS | Decrease barotraumas, reduce overdistention of the lungs |
| A phrenic pacemaker is normally recommended for the patient suffering from obstructive sleep apnea | FALSE |
| Direct thermal injuries normally do not occur below the level of the larynx execpt in the rare instance of steam inhalation | TRUE |
| The half-life of CO in the patient breathing room air at 1 atm is approximately | 5 hours |
| Obstructive sleep apnea appears to be the most severe in what sleep position | supine postition |
| Hyperbaric oxygen therapy is always used for the elimination of CO in the smoke inhalation victim | FALSE |
| Thermal injury occurring to the distal airways post inhalation of steam results | COP, BOOP |
| The thymus gland in many myasthenic patients appears to be the source of anti-Ach receptor antibodies | TRUE |
| Which of the following medications are useful in the treatment of blood pressure and cardiac disturbances for the patient with Guillain-Barre syndrome | Nipride, Atropine, Phentolamine |
| Even when diagosed early, patients suffering from Guillain- Barre syndrome have a poor progonosis for recovery | FALSE |
| The diagnosis of sleep apnea is made based on patients who have more than five episodes of apnea per hour. These episodes occur only in non-REM sleep over a 3 hour period | FALSE |
| Which of the following are considered etiologic factors associated with ARDS | Drug overdose, shock, Infections, Oxygen toxicity, Aspiration |
| The distal airways and alveoli are usually protected from thermal injury by | reflex laryngospasm, glottic closure |
| The diagnosis of sleep apnea may be confirmed by confirmed by polysomnographic sleep studies | TRUE |
| ARDS is considered an obstructive lung disorder | FALSE |
| The etiology of myasthenia gravis appears to be associated _________ antibodies that block nerve impulse transmission at the neuromuscular junction | IgG |
| Select the signs and symptoms below that may be associated with obstructive sleep apnea | Shortness of breath following abrupt awakenings, Nocturnal enuresis, Morning headache, Snoring loudly |
| Treatment for cyanide poisoning may include IV sodium thiosulfate and inhalation of amyl nitire | TRUE |
| Serum levels of IgM antibodies against myelin glycolipid have been found to be ________ in the patient with Guillain-Barre syndrome | elevated |
| Mixed sleep apnea is a combination of central and obstructive sleep apnea and commonly begins as OSA | FALSE |
| Third spacing fluid shifts associated with body surface burns can result in intravascular volume loss (hypovolemia) | TRUE |
| The 3 Primary types of sleep apnea are classified as | Obstructive sleep apnea, Mixed sleep apnea I, Central sleep apnea |
| Chest xray findings associated with ARDS include | Increased opacity and Ground glass appearance |
| CO poisoning can greatly reduce oxygen transport because its affinity for hemoglobin is 400 times greater than that of oxygen | FALSE |
| Myasthenia gravis is more common in younger men | FALSE |
| Select the appropriate treatment for the patient who has recently inhaled hot gases and exhibits signs of impending UAO | Endotracheal intubation |
| The signs and symptoms of thermal injury associated with smoke inhalation can always be identified immediately, especially when extensive body surface burns are present | FALSE |
| Select from the list below the major structual or pathologic lungs changes that may be associated with ventilatory failure accompanying myasthenia gravis | Atelectasis, Airway obstruction, Alveolar consolidation, Accumilation of mucus |
| Most thermal injuries affect the distal airways and alveoli | FALSE |
| The use of plasmapheresis in treatment of Guillian-Barre syndrome is aimed at the removal of damaged antibodies from the patient's blood plasma and has shown to be effective in reducing the antibody titer during early stages of the disease | TRUE |
| Which of the following are considered beneficial in managing the patient with Guillian- Barre syndrome | Frequent measurement of the patient's VC, BP, and NIF, Heparin therapy, Measurement of the patient's oxygen saturation, Plasmapheresis, Aterial blood gas measurement |
| What techniques may be useful in the diagnosing of myasthenia gravis | CT and/or MRI, Blood analysis, Electromyography, Evaluating the patient's clinical history, Endrophonium testing, Neurologic examination |
| Coricosteriod therapy has been shown to be effective in the treatment of Guillain-Barre ayndrome and shorten | False |
| What chronic neurologicval disorder is characterized by the interference of acetylcholine between the axonal terminal and the receptor sites of voluntray muscle | Myathenia Graivs |
| Which of the following describes obstructive sleep apnea (OSA) | Its cause is an anatomic obsruction of the upper airway in the presence of continued ventilatory effort |
| The chest radiograph associated with smoke inhalation | is usually normal during the early stage |
| All of the following are considered major pathological or structual changes associated with ARDS | Alveolar consolidation, Atelectasis, Intra-alveolar hyaline membrane formation |
| Which of the following describes the strategy of reducing the tidal volume thereby allowing the patient's PaCO2 to increase in order to protect the lungs from high airway pressures | Permissive hypercapnia |
| Apnea is defined as the cessation of breathing for | 10 seconds or longer |
| a burn identified as full thickness of the skin including tissue beneath the skin describes a | 3rd degree burn |
| Pathologic changes in the distal airways and alveoli mainly caused by irritating and toxic gases are commonly associated with | smoke inhalation |
| Sleep apnea that occurs with the cessation of inspiratory efforts as the result of the respiratory centers of medulla failing to send signals to the respiratory muscles is known as | CSA |
| The following events may occur during REM sleep | Negative pressure generated by the diaphragm produces paradoxical motion of the rib cage, Loss of muscle tone in the upper airway can result in airway obstruction, the heart rate can become irregular |
| Treatment modalities for managing sleep apnea may include | UPPP, Nocturnal CPAP used to treat OSA, Phrenic nerve pacemarker used to treat central sleep apnea |
| The mucosa of the tracheobronchial tree very often becomes necrotic and sloughs ________ post inhalation of smoke | 3-4 days |
| Select the clinical finding below that may be associated with Guillain-Barre syndrome | Negative inspiratory force (NIF) measurement is decreased |
| Correct sequence of events resulting in the manifestation of ARDS | Pulmonary capillaries engorgement post-injury, Increased permeability of the alveolar-capillary membrane, Evidence of intra-alveolar edema and hemorrhage, decreased surfactant, Alveolar collapse and atelectasis |
| Which of the following are true regarding NON-REM sleep? | Non-REM sleep consists of 4 separate stages of sleep, Non-REM sleep usually lasts 60 to 90 minutes, It is possible for an individual to move directly into REM sleep from any of the 3 stages of Non-REM sleep |
| A burn identified as superficial to deep thickness describes | a 2nd degree burn |
| Which of the following may anti-cholinesterase agents may be used to help treat myasthenia gravis | Prostigmin, Pyridostigmine, Mestinon, Neostingmine |
| During periods of sleep apnea the heart rate ______ then _______ after termination of the apne | decreases then increases |
| Which of the following are clinical findings that may be associated with myasthenia gravis | Decreased tidal volume, Increased pulmonary shunting, Decreased DO2 |
| The onset of Guillain-Barre syndrome usually occurs ____________ | 1 to 4 weeks after a febrile episode such as a mild upper respiratory infection |
| The initial care of the burn patient should include assessment of the following | Cardiovascular status, Respiratory status, Percentage of body burned, Patient's airway |
| Which of the following appear to attack and strip off the myelin sheath of the peripheral nerves and leave selling/fragmentation of the neural axon in Guillain-Barre syndrome | Lymphocytes and Macrophages |
| The current ventilation strategy for the majority of patients with ARDS suggests the use of | initial tidal volumes of 5 to 7 ml/kg, Ventilatory rates as high as 35bpm in order to maintain adequate minute ventilation, low tidal volumes and high respiratory rates, PEEP and CPAP to reduce atelectasis |
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