Term
| What is the information obtained in most history exams |
|
Definition
| Biographical data (age, gender, occupation); patient's chief complaint, present health or history of present illness; past health; patient's family history; review of each body system; functional assessment (activities of daily living, i.e. exercise, sleep, nutrition, relationships, coping skills) |
|
|
Term
|
Definition
| Asks the patient to provide narrative information. commonly used to begin the interview, introduce new section of questions, and to gather further information whenever a patient introduces a new topic. it is unbiased, allows freedom, greater length, spontaneous account |
|
|
Term
| What are the four vital signs |
|
Definition
| body temperature (T); Pulse (P); Respiratory Rate (RR); Blood pressure (BP) |
|
|
Term
|
Definition
| a heart rate lower than 60 |
|
|
Term
|
Definition
| Increased rate and depth of breathing, usually associated with ketoacidosis as compensatory mechanism to rid carbon dioxide, by buffering the metabolic acidosis |
|
|
Term
|
Definition
|
|
Term
| What type of percussion note is heard in atelectasis or pleural effusion |
|
Definition
| dull percussion note - b/c the sounds do not freely vibrate throughout the lungs (like knocking on a full barrell) |
|
|
Term
| Calculate airway resistance |
|
Definition
| Raw = change in pressure divided by volume - i.e. if a patient produces a flow rate of 6 l/sec during inspriation by generating a transairway pressure difference of 12 cm H2O, Raw would be 2 because 12/6 = 2 |
|
|
Term
| Oxygen's effect on capillary shunt and shuntlike effect |
|
Definition
| with capillary shunt - refractory to oxygen therapy because the alveoli are unable to provide any 02/co2 exchange function. shuntlike effect - responds to O2 therapy because capillary perfusion is in excess of alveolar ventilation therefore increased O2 helps the situation! |
|
|
Term
| Type of secretions found in the patient with "pulmonary edema" |
|
Definition
| thin, frothy, pinkish sputum - is not true sputum, but it results from the movement of plasma and red blood cells across the alveolar-capillary membrane into the alveoli |
|
|
Term
| Typical blood gases associated with acute ventilatory failure with hypoxemia |
|
Definition
| Ph is decreased (7.21); Paco2 is increased (79 mmHg); HCO3 is increased slightly (28); Pa02 is decreased (57 mmHg) |
|
|
Term
| Lung Volume and capacity findings associated with restrictive and obstructive disorders |
|
Definition
| restrictive - VC, IC, RV, FRC, Vt and TLC are all decreased. Obstructive - RV, Vt, FRC and RV/TLC ratio are increased, and the VC, IC, IRV and ERV are decreased. |
|
|
Term
| Disorders associated with increased A-a Gradient (P(A-a)O2) |
|
Definition
| Oxygen diffusion disorders (chronic interstitial lung disease), decreased ventilation/perfusion ratios disorders (COPD, atelectasis, consolidation), right-to-left intracardiac shunting (patent ventricular septum), and age. |
|
|
Term
|
Definition
| inadequate oxygenation at the tissue level. characterized by tachycardia, increased respiratory rate, hypertension, peripheral vasoconstriction, dizziness, and mental confusion. |
|
|
Term
| Different mechanisms responsible for cor pulmonale |
|
Definition
| pulmonary arterial hypertension, right ventricular hypertrophy, incrased right ventricular work and right ventricular failure. The three major mechanisms are increased viscosity of blood associated with polycythemia, increased pulmonary vascular resistance caused by hypoxic vasoconstriction, the obliteration of the pulmonary capillary bed, particularly emphysema |
|
|
Term
| What is the normal range for "Mean Pulmonary Artery Pressure" and "PCWP" |
|
Definition
|
|
Term
| Identify organisms that are either gram positive or gram negative |
|
Definition
| Gram negative - Klebsiella, Pseudomonas aeruginosa, haemophilus influenzae, legionella pneumophila. Gram positive - streptococcus (80% of all bacterial pneumonias) staphylococcus |
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|
Term
| Radiologic tecnhique that is useful in diagnosing pleural effusion |
|
Definition
| The lateral decubitus radiograph is useful in the diagnosis of a suspected or known fluid accumulation in the pleural space (pleural effusion) that is not easily seen in the PA radiograph |
|
|
Term
| Techniques that are useful in diagnosing pulmonary embolism |
|
Definition
| pulmonary angiography, ventilation/perfusion scan |
|
|
Term
|
Definition
| Subjective, Objective, Assessment, Plan, Implementation Evaluation, Revision |
|
|
Term
|
Definition
| Subjective - information about the patient's feelings, concerns, or sensations presented by the patient. only the patient can provide subjective information |
|
|
Term
|
Definition
| Objective - data the RT can meausure, factually describe, or obtain from other professional reports or test results |
|
|
Term
|
Definition
| Assessment - refers to the practitioner's professional conclusion about the cause of the subjective and objective data presented by the patient |
|
|
Term
|
Definition
| Plan - therapeutic procedure selected to remedy the cause identified in assessment |
|
|
Term
|
Definition
| Implementation - actual administration of the specific therapy plan |
|
|
Term
|
Definition
| Evaluation - the collection of the meausurable data regarding the effectivness of the therapy plan and the patient's response to it |
|
|
Term
|
Definition
| Revision - refers to any changes that may be made to the original therapy plan in response to the evaluation |
|
|
Term
|
Definition
| Health Insurance Portability and Accountability Act - all health care workers who have access to patient records must prove that they have a plan to protect the privacy of the patient's records |
|
|
Term
| Objective for mechanical ventilation |
|
Definition
| improve and maintain alveolar ventilation; to ensure adequate CO2 and pH homeostasis, oxygenation, and lung inflation; and to reduce the work of breathing |
|
|
Term
| Recommended initial setting for PEEP on a ventilator |
|
Definition
|
|
Term
| Etiologic factors and structural/pathologic changes associated with chronic bronchitis |
|
Definition
| cigarette smoking, atmospheric pollutants, infection, gastroesophageal reflux disease; chronic inflammation and swelling of the peripheral airways, excessive mucus production and accumulationn, partial or total mucus plugging, hyperinflation of alveoli, smooth muscle constrictin of bronchial airways - additionally, continued bronchial irritation causes the submucosal bronchial glands to enlarge and the number of goblet cells to increase resulting in excessive mucus production. the number and function of cilia lining the tracheobronchial tree are diminished, and the peripheral bronchi are often partially or totally occluded b inflammation adn mucus plus, which leads to hyperinflated alveoli |
|
|
Term
| Definition of chronic bronchitis according to the American Thoracic Society |
|
Definition
| daily productive cough for at least 3 consecutive months each year for 2 years in a row. |
|
|
Term
| typical arterial blood gas and PFT values seen in the patient with "severe" chronic bronchitis |
|
Definition
| Normal pH, increased Paco2, Significantly increased HCO3-, decreased PaO2/ PFT - all decreased (FVC, FEVt, FEF25%-75%, FEF200-1200, FEFR, MVV, FEF50%, FEV1%) |
|
|
Term
| The main bronchodilators used in the treatment of COPD |
|
Definition
| combining drugs with different mechanisms of action and durations - short-acting B2 agonist and anticholinergic like ipratropium |
|
|
Term
Differentiate between the structural changes in
panlobular vs. centriloblar emphysema. Also cite
the major cause of emphysema |
|
Definition
| panlobar emphysema - abnormal weakening and enlargement of all air spaces distal to the terminal bronchioles, including the respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli - lower parts of the lungs, deficiency of a1-protease called a1-antitrypsin---------centrilobar emphysema - respiratory bronchioles in the proximal portion of the acinus. respiratory bronchioles enlarge become confluent, and are then destroyed. a rim of parenchyma remains unaffected. most common and associated with chronic bronchitis - cigarettes most common cause |
|
|
Term
Clinical findings associated with emphysema
(PEFR, CVP, FEVT, PVR, and RV) |
|
Definition
| PEFR decreased, CVP increased, FEVt decreased, PVR increased, RV increased |
|
|
Term
| Define “intrinsic asthma” |
|
Definition
| asthma that occurs in the absence of an antigen-antibody reaction |
|
|
Term
Recognize the sequential steps involved in the
immunologic mechanism associated with an
asthma attack |
|
Definition
| 1)antigen exposure, lymphoid tissue cells form specific IgE antibodies which attach to surface of mast cells in bronchiole walls 2) reexposure or continued exposure to same antigen which creates an antigen-antibody reaction on the surface of the mast cell -releases chemical mediators 3) the release of these mediators stimulates parasympathetic nerve endings in the bronchial airways leading to reflex bronchoconstriction and mucus hypersecretion, and increase the permeability of capillaries resulting in dilation of blood vessels and tissue edema |
|
|
Term
| Clinical PFT findings associated with asthma (FRC, RV/TLC Ratio, MVV, PEFR, TLC) |
|
Definition
FRC increased, RV/TLC ratio increased, MVV decreased, PEFR decreased, TLC increased
asthma causes airway constriction along with mucus production. This causes air trapping and alveolar hyperinflation - hence increased FRC, increased RV/TLC, decreased MVV, decreased PEFT and increased TLC |
|
|
Term
Identify typical medications / agents used to treat
asthma |
|
Definition
| xanthines, corticosteroids, cromolyn sodium, nedocromil sodium, leukotriene inhibitors- sympathomimetic and parasympatholytic agents |
|
|
Term
Identify the names describing the type of
bronchiectasis that exhibits bronchi that have
regular outlines similar to a tube. |
|
Definition
| cylindrical bronchiectasis |
|
|
Term
Recognize the type of sputum associated with
bronchiectasis |
|
Definition
|
|
Term
Major structural changes associated with
pnuemonia |
|
Definition
| inflammation of the alveoli, alveolar consolidation, atelectasis (aspiration pneumonia) |
|
|
Term
Radiographic findings associated with alveolar
consolidation related to penumonia |
|
Definition
| increased density (from consolidation and atelectasis), air bronchograms, pleural effusions |
|
|
Term
Determine whether pneumonia is a restrictive or
obstructive disease |
|
Definition
|
|
Term
Identify the organisms primarily responsible for
causing pneumonia in the hospitalized patient |
|
Definition
| P.aerruginosa S. aureus, k. pneumoniae, E. coli, serratia species, and oral anaerobes |
|
|
Term
Treatment protocols for the management of
postoperative atelectasis. |
|
Definition
| Oxygen therapy protocols, bronchopulmonary hygiene therapy protocols, hyperinflation therapy protocol, mechanical ventilation protocol |
|
|
Term
| The disorders that make up COPD |
|
Definition
| Chronic bronchitis, emphysema, asthma, chronic bronchitis/asthma/emphysema in any combo, bronchiectasis (less commonly) |
|
|
Term
Radiographic findings associated with chronic
bronchitis |
|
Definition
| Translucent (dark) lung fields, depressed or flattened diaphragms, long and narrow heart (pulled down by diaphragm), enlarged heart |
|
|
Term
|
Definition
| necrosis of lung tissue that, in sever cases, leads to a localized air and fluid filled cavity. The fluid is a collection of purulent exudate that is composed of liquefied white blood cell remains, proteins, and tissue debris. the air and fluid filled cavity is encapsulated in a so-called pyogenic membrane consisting of a layer of fibrin, inflammatory cells, and granulation tissue. |
|
|
Term
| First line drugs used to treat TB |
|
Definition
| two to four drugs, for 6 - 12 months. Isoniazid (INH) and rifampin (Rifadin) are first-line agents prescribed for the entire 9 months |
|
|
Term
| Wheal size in a positive TB test |
|
Definition
|
|
Term
| Identify the area of the lungs where TB spores flourish |
|
Definition
|
|
Term
| Most common type of fungal infection in the U.S |
|
Definition
|
|
Term
Medication of choice used to treat
“histoplamosis" |
|
Definition
|
|
Term
Where “histoplasmosis” is commonly found in the
lungs |
|
Definition
| apical and posterior segments of the upper lobes |
|
|
Term
| Causes of cardiogenic pulmonary edema |
|
Definition
| arrhythmias producing low cardiac output, congenital heart defects, excessive fluid administration, left ventricular failure, mitral or aortic valve disease, myocardial infarction, pulmonary embolus, renal failure, rheumatic heart disease (myocarditis), systemic hypertension |
|
|
Term
| Causes of non cardiogenic pulmonary edema |
|
Definition
| allergic reaction to drugs, excessive sodium consumption, drug overdose, metal poisoning, chronic alcohol ingestion, aspiration, central nervous system stimulation, encephalitis, cardiac tamponade, high altitudes |
|
|
Term
Major structural / pathologic changes in
pulmonary edema. |
|
Definition
| interstitial edema including fluid engorgement of the perivascular and peribronchial spaces and the alveolar wall interstitium; alveolar flooding; increased surface tension of pulmonary surfactant; alveolar shrinkage and atelectasis; frothy white (or pink) secretions throughout the tracheolbronchial tree |
|
|
Term
| The use of mask CPAP to treat pulmonary edema |
|
Definition
| improves decreased lung compliance, decreases the work of breathing, enhances gas exchange, and decreases vascular congestion in patients with pulmonary edema. prescribed for patients with pulmonary edema who have arterial blood gas values that reveal impending or acute ventilatory failure. |
|
|
Term
| Define pulmonary embolism |
|
Definition
| Occurs when a blood clot (thrombus) becomes dislodged from veins elsewhere in the body and moves into the pulmonary arterial circulation. |
|
|
Term
Various methods of testing that are useful in the
diagnosis of pulmonary embolism |
|
Definition
| Chest X-ray (often normal, can be used to rule out conditions that mimic emblism); ECG (excellent test to rule out other disorders); V/Q scan (reliable only at the extremes of interpretation); CT scan (fast and less invasive); pulmonary angiogram extremely accurate however invasive); |
|
|
Term
|
Definition
[image]
result of double fractures of at least three or more adjacent ribs, which causes the thoracic cage to become unstable
|
|
|
Term
Different procedures, protocols and
medications for managing the patient with flail
chest |
|
Definition
| stabilization of the chest is required to allow bone healing and prevent atelectasis - volume controlled ventilation, accompanied by positive end-expiratory pressure (PEEP), is commonly used to stabilize a flail chest; oxygen therapy protocol, hyperinflation therapy protocol, mechanical ventilation protocol |
|
|
Term
|
Definition
| exists when gas (sometimes called "free air") accumulates in the pleural space. when gas enters the pleural space, the visceral and parietal pleura separate. This enhances the natural tendency of the lungs to recoil, or collapse, and the natural tendency of the chest wall to move outward, or expand |
|
|
Term
Major pathologic and structural
changes associated with a pneumothorax |
|
Definition
| Lung collapse, atelectasis, chest wall expansion, compression of the great veins and decreased cardiac venous return |
|
|
Term
When to employ the use a chest tube to treat a
pneumothorax |
|
Definition
| When pneumothorax is larger than 20%, it should be evacuated. In less severe cases, air may simply be withdrawn from the pleural cavity by needle aspiration, In more serious cases, a chest tube attached to an underwater seal is inserted into the patient's pleural cavity |
|
|
Term
The most common cause of pleural
effusion (2) The major causes of an
exudative effusion |
|
Definition
| Congestive heart failure is probably the most common cause of pleural effusion. Exudate is usually caused by inflammation, infection, or malignancy |
|
|
Term
Describe the type fluid that makes up a
transudative pleural effusion |
|
Definition
| thin and watery, containing a few blood cells and little protein |
|
|
Term
|
Definition
| the accumulation of pus in the pleural cavity |
|
|
Term
| Define the term hemothorax |
|
Definition
| presence of blood in the pleural space |
|
|
Term
Type of mediastinal shift associated with a pleural
effusion |
|
Definition
| mediastinal shift to unaffected side |
|
|
Term
Structural / pathologic changes associated with
pleural effusion |
|
Definition
| Lung compression, atelectasis, compression of the great veins and decreased cardiac venous return |
|
|
Term
| Radiographic technique used for identifying a pleural effusion |
|
Definition
[image]
pleural effusion of less than 300 ml usually cannot be seen on upright chest x-ray. moderate pleural effusion in upright position, increased density usually appears at the costophrenic angle. The lateral costophrenic angle is obliterated, a so-called meniscus sign may develop, and the outline of the diaphragm on the affected side is lost
|
|
|
Term
Type of breath sounds, fremitus, and percussion
note associated with kyphoscoliosis |
|
Definition
| bronchial breath sounds, increased tactile and vocal fremitus, dull percussion note |
|
|
Term
|
Definition
| general term used to describe diseases of the lungs that are caused by the chronic inhalatin of inorganic dusts and particulate matter, usually of occupational or environmental origin (coal dust, asbestos, silica) |
|
|
Term
Structural / pathologic changes associated with
pneumoconiosis |
|
Definition
| destruction of alveoli and adjacent pulmonary capillaries, fibrotic thickening of the respiratory bronchioles, alveolar ducts, and alveoli; cystlike structures (honeycomb appearance); fibrocalcific pleural plaques (particularly in asbestosis); airway obstruction caused by inflammation and excessive bronchial secretions; bronchogenic carcinoma; mesothelioma ( in asbestosis) |
|
|
Term
| Describe the chest radiograph for the patient suffering from asbestosis |
|
Definition
| [image]small round opacities scattered throughout the lung, irregularly shaped opacities, irregular cardiac and diaphragmatic borders, pleural plaques, honeycomb appearance |
|
|
Term
Identify the type of hypoxemia associated with
capillary shunting in “pneumoconiosis” |
|
Definition
| most commonly caused by th ealveolar thickening, fibrosis, and capillary shunting associated with the disorder |
|
|
Term
|
Definition
| general term that refers to abnormal new tissue growth characterized by the progressive uncontrolled multiplication of cells, which is called a neoplasm or tumor which may be localized or invasive, benign or malignant |
|
|
Term
Identify those types of cancers that are considered
non-small cell lung cancer. |
|
Definition
| squamous (epidermoid) cell carcinoma; adenocarcinoma (including bronchioalveolar cell carcinoma), large-cell carcinoma (undifferentiated) |
|
|
Term
| Type of lung cancer most associated with smoking |
|
Definition
| small-cell (oat cell) carcinoma |
|
|
Term
| Describe the origin of squamous cell carcinoma |
|
Definition
| hilar region, projecting into the large bronchi. originates from basal cells of bronchial epithelium and grows through the epithelium before invading the surrounding tissue |
|
|
Term
Lettering and numeric elements of the TNM
classification system for staging lung cancer |
|
Definition
| T-extent of primary tumor, N denotes the lymph node involvement, M extent of metastasis. 0 least advanced and IV the most advanced |
|
|
Term
Best treatment option for the patient with smallcell
carcinoma of the lung |
|
Definition
| most effective treatment is chemotherapy, either alone or in combination with radiation therapy |
|
|
Term
| Is ARDS an obstructive or restrictive disease? |
|
Definition
|
|
Term
Major structural / pathologic changes associated
with ARDS |
|
Definition
| interstitial and intra-alveolar edema and hemorhage; alveolar consolidation; intra-alveolar hyaline membrane; pulmonary surfactant deficiency or abnormality; atelectasis |
|
|
Term
Ventilation strategy for managing the patient with
ARDS in terms of setting the tidal volume and
respiratory rate |
|
Definition
| low tidal volumes and high respiratory rates. Initial tidal volume is usually set at 4 to 8 ml/kg, compared with 12 to 15 ml/kg for pt without ARDS. |
|
|
Term
| Refractory hypoxemia associated with ARDS |
|
Definition
| hypoxemia caused by capillary shunting often is refractory to oxygen therapy |
|
|
Term
Commonly prescribed medications used in the
treatment of ARDS |
|
Definition
| antibiotics, diuretic agents, corticosteroids |
|
|
Term
| Define “extrinsic allergic alveolitis” |
|
Definition
| aka hypersensitivity pneumonitis, an immunologically mediated inflammation of the lungs caused by the inhalation of a variety of offending agents (antigens) such as pollen, animal dander, organic dusts, and spores of certain molds |
|
|
Term
Clinical findings associated with chronic interstitial
lung disease (ABGs, PFTs, Shunting and DO2) |
|
Definition
| ABG mild - increased pH, decreased Paco2, decreased HCO3 (slightly), decreased pa02. ABG severe - normal pH, increased paco2, significantly increased bicarb, decreased PaO2. PFT - all decreased but RV/TLC%. shunting, increased Qs/Qt, decreased DO2, VO2 is normal, C(a-v)O2 normal, increased O2ER, decreased Svo2 |
|
|
Term
Goal of plasmapheresis in treating chronic
interstitial lung disease. |
|
Definition
| directly removes the anti-GBM antibodies from the circulation - tx is directed at reducing the circulating anti-GBM antibodies that attack the patient's glomerular basement membrane |
|
|
Term
|
Definition
| flaccid paralysis of skeletal muscles and loss of reflexes. |
|
|
Term
| What is the usual onset of GBS? |
|
Definition
| frequently occurs 1 to 4 weeks after a febrile episode such as upper respiratory or gastrointestinal illness. nerous viruses and some bacterial agents have been implicated as precursors to Guillain-Barre syndrome. |
|
|
Term
|
Definition
| 1 to 2 per 100,000, mortality is 4% - 6%, morbidity rate is 5% - 10%. all age groups and genders, male caucasians over 45 account for 50% - 60%. no obvious seasonal clustering; immune disorder causing inflammation and deterioration of peripheral nervous system. lymphocytes and macrophages attack and strip myelin sheath covering peripheral nerve. |
|
|
Term
Structural / pathologic changes associated with
GBS |
|
Definition
| mucus accumulation, airway obstruction, alveolar consolidation, atelectasis |
|
|
Term
| The goal of plasmapheresis in GBS |
|
Definition
| effective in decreasing the morbidity and shortening the clincial course of Guillan-Barre. Removes the antibodies from the plasma that contribute to the immune system attack on the peripheral nerves. Shown to reduce antibody titers during the early stages of the disorder |
|
|
Term
| Identify treatment modalities beneficial in the management of the GBS patient |
|
Definition
| plasmapharesis, infusion of immunoglobulin (ig-used by the immune system to identify and neutralize foreign objects, such as bacteria and viruses), corticosteroids; respiratory care treatment protocols (oxygen therapy, bronchopulmonary hygiene, hyperinflation, mechanical ventilation, ) physical therapy and rehabilitation |
|
|
Term
Identify non-cardiopulmonary manifestations
associated with myasthenia gravis. |
|
Definition
| weakness of striated muscles - eye muscles drooping of upper eyelids; extraocular muscles - double vision; muscles of lower portion of the face - speech impairment; chewing and swallowing muscles; skeletal muscles of the arms and legs. |
|
|
Term
Useful techniques used in diagnosing myasthenia
gravis |
|
Definition
| clinical history; neurologic examination; electromyography; blood analysis; edrophonium test; CT or MRI |
|
|
Term
Beneficial treatment modalities in managing the
severely ill patient with myasthenia gravis. |
|
Definition
| cholinesterase inhibitors; immunosuppressants; adrenocorticotropic hormone therapy; thymectomy; plasmaphersis |
|
|
Term
| Identify the probable cause of myasthenia gravis |
|
Definition
| circulating antibodies of the autoimmune system which disrupt the chemical transmission of ACh at the neuromuscular junction by blocking the ACh from teh receptor sites of the muscular cell, accelerating the breakdown of ACh, and destroying the receptor sites. Thymus gland is almost always abnormal and it is generally presumed that the antibodies arise within the thymus or in related tissue |
|
|
Term
Clinical findings associated with myasthenia gravis
(PFTs, ABGs, DO2, and Shunting) |
|
Definition
| PFT - all decreased; ABGs are decreased pH, increased PaCO2, increased bicarb; decreased PaO2; Do2 is decreased, Qs/Qt is increased |
|
|
Term
Describe the role of the thymus gland in
myasthenia gravis |
|
Definition
| Thymus gland is almost always abnormal and it is generally presumed that the antibodies arise within the thymus or in related tissue |
|
|
Term
Recognize the treatment options for managing the
patient with myasthenia gravis |
|
Definition
| cholinesterase inhibitors; immunosuppressants; adrenocorticotropic hormone therapy; thymectomy; plasmapharesis |
|
|
Term
Cite the most common sleep disorder seen in the
clinical setting |
|
Definition
|
|
Term
Recognize the general clinical manifestations
associated with obstructive sleep apnea (OSA). |
|
Definition
| chronic loud snoring, hypertension, morning headache, systemic hypertension, CHF, nausea, dry mouth on awakening, intellectual and personality changes, depression, sexual impotence, nocturnal enuresis, excessive daytime sleepiness, automobile accidents or job malperformance, pulmonary hypertension and/or cor pulmonale |
|
|
Term
Recognize that polysomnography as a means of
diagnosing OSA |
|
Definition
| diagnosis and type of sleep apnea are confirmed with polysomnographic sleep studies |
|
|
