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Diseases Exam 3
| Question | Answer |
|---|---|
| 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
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