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Diseases Exam 3

What is Myasthenia Gravis? Chronic disorder of the neuromuscular junction that interferes with the chemical transmission of Ach between the axon terminal and the receptor site of voluntary muscles; characterized by fatigue and weakness that improves following rest
What is the most common age and sex affected by Myasthenia Gravis? Young women: 15-35 and Older men 40 to 70
What provokes Myasthenia Gravis? Emotional upset, physical stress, exposure to extreme temp changes, febrile illness, pregnancy
What are the clinical manifestations associated with Myasthenia Gravis? RR varies with the degree of muscle paralysis, apnea occurs in severe cases, cyanosis in severe cases, diminished BS, crackles, and rhonchi
What is ptosis? Drooping of one or both eyelids
What is diplopia? Double vision
What tests are used to diagnose Myasthenia Gravis? Clinical history, neurological exam, electromyography, blood analysis, edrophonium test, ice pack test, sleep test, CT scan, MRI
What test is used to determine the muscles affected by Myasthenia Gravis and the degree of fatigability? Electromyography
What are the indicators of acute vantilatory failure? VC<20 mL/kg, NIF<-25 cmH2O (-80 cmH2O is normal), pH<7.35 or PaCO2>45 mmHg
Are the PFTs associated with Myasthenia Gravis restrictive or obstructive? Restrictive
How is VC calculated when you know the patient's weight? 20mL/kg
What drugs are used to treat Myasthenia Gravis? Cholinesterase inhibitors (Pyridostigmine - 1st line treatment), immunosuppressants
What is a thymectomy and why would it be used for myasthenia gravis? Removal of the thymus gland; the thymus appears to be the source of the Ach receptor antibodies
What is Guillan Barre? Causes inflammation and deterioration of the peripheral nervous system; elevated levels of IgM are present. Lymphocytes and macrophages appear to attack and strip off the myelin sheath of the peripheral nervous system. Onset 1-4 weeks after fever
What are the anatomical alterations associated with Guillan Barre? (Including the affect on nerves and changes in the lungs) RR varies with severity, apnea in severe cases, crackles and rhonchi, diminished breath sounds, mucus accumulation, airway obstruction, alveolar consolidation, atelectasis, demyelination
Who is at the greatest risk for developing Guillan Barre? 45 years of age of older (Men)
What is the clinical presentation of Guillan Barre? Symmetrical muscle weakness, pain, numbness, muscle paralysis spreads upward, patient often drools has difficulty chewing, swallowing, and speaking, respiratory muscle paralysis
How is Guillan Barre diagnosed? Clinical history (sudden paralysis), CSF findings, EMG findings, CXR, and nerve conduction studies
What are the breath sounds associated with Guillan Barre? Crackles, rhonchi, diminished
What are the PFT's associated with Guillan Barre? Restrictive
What are the indicators of ventilatory failure? VC<20 mL/kg, NIF<-25 cmH2O (-80 cmH2O is normal), pH<7.35 or PaCO2>45 mmHg
What is used to prevent thrombus formation in a bedridden patient? Leg compression devices, compression socks, physical therapy
What is obstructive sleep apnea? Blockage of ventilation due to upper airway obstruction. No airflow despite chest and abdomen movement
What is central sleep apnea? Occurs when respiratory centers of the medulla fail to send signals to the respiratory muscles
What diseases are associated with central sleep apnea? Cardiovascular, metabolic, and central nervous system disorders
What are the most common symptoms of obstructive sleep apnea? Snoring, periods of apnea, insomnia, abrupt awakenings with SOB, hypersomnia
What is the most common treatment for obstructive sleep apnea? What is it used to prevent? CPAP, prevents airway collapse
What is the most common treatment for central sleep apnea? VPAP
What is the healing time for 2nd degree burns? 7-21 days
What are the problems associated with patient deterioration following burns? Decreased lung compliance, used of narcotics, immobility, increased airway resistance
What should be done if a patient has burns around their face? Intubate immediately
What is the best treatment for smoke inhalation? 100% O2 therapy
What materials produce CO when burned? Wood, cotton, paper, organic materials, PVC
What is Hgb's affinity for CO in comparison to O2? 210x greater
What are the symptoms of >20% CO poisoning? Throbbing headache, nausea, vomiting, impaired judgement
What are the symptoms of >30% CO poisoning? Throbbing headache, possible syncope, increased RR and HR
What are the symptoms of >60% CO poisoning? Coma, convulsions, cardiovascular and respiratory distress, Cheyne-stokes respirations
What is Scleroderma (ILD)? Characterized by chronic hardening and thickening of the skin caused by new collagen formation
What is CWP? Pulmonary deposition and accumulation of large amounts of coal dust
What is Asbestosis? Caused by exposure to asbestos fibers
What is Sarcoidosis? Systemic granulomas disease, characterized by the formation of tubercles (noncaseating granulomas), unknown origin
What is Silicosis? Caused by chronic inhalation of crystalline, free silica, or silicon dioxide particles
How do ILDs affect the lung volumes and capacities? Decreased
Define near drowning An incident of potentially fatal submersion in liquid that did not result in death or in which death occurred more than 24 hours after submersion
Define dry drowning Glottis spasms preventing water from entering the lungs (10-15% die from asphyxia)
Define wet drowning Glottis relaxes and allows water to flood the lungs (85-90% of victims aspirate fluid)
What is the most common cause of drowning in adults? Alcohol
Who is more likely to survive drowning in reference to age and water temperature? A younger person in cold water
What will the CXR look like on a drowning patient? Fluffy infiltrates, normal to showing varying degrees of pulmonary edema and atelectasis, rapid deterioration
What are the major pathological changes associated with drowning? Laryngospasm, edema, decreased surfactant, frothy, white pink sputum, atelectasis, consolidation, bronchospasm
What are the breath sounds associated with drowning? Crackles and rhonchi
What is the first priority in a drowning patient? CPR
What type of ventilatory support do most drowning victims need? Mechanical ventilation with PEEP or CPAP
What causes atelectasis? Develops when lung expansion is decreased or when excess airway secretions cause mucus plugs (airway obstruction)
What surgical procedures put a patient at risk of atelectasis? Abdomen and thoracic surgery
What will the CXR look like in a patient with atelectasis? Increased density in areas of atelectasis (cloudy, white), air bronchograms, elevation of hemi-diaphragm on the affected side, mediastinal shift toward the affected side
How is atlectasis treated? Treat underlying cause immediately, O2 therapy, bronchopulmonary hygiene, lung expansion therapy, mechanical ventilation
What causes hypoxemia in ARDS patients? Widespread alveolar consolidation, atelectasis, increased A/C membrane thickening, refractory to O2 therapy due to pulmonary capillary shunting
What does a typical ARDS x ray look like? Increased opacity, the more severe = the white the lungs, "ground glass" appearance
What is the ventilatory strategy for ARDS? Low tidal volume and high RR
What ABG would be found in a patient with severe ARDS? Acute ventilatory failure with hypoxemia
How is refractory hypoxemia treated? Lung expansion therapy
What is the criteria for respiratory failure? PaO2 < 60 mmHg and/or PaCO2 > 50 mmHg
What is the difference between pulmonary shunting and deadspace? Shunting = perfusion without ventilation / Deadspace = ventilation without perfusion
What breath sounds might be heard in a patient with ARDS? Diminished, wheezing, crackles
Created by: ashconrad417