Respiratory Diseases Quiz

Questions and Answers

What are the symptoms at LEVEL I for Emphysema?

Cyanosis (correct)

Wheezing breath sounds

Barrel chest (correct)

Dyspnea

What is the main oxygen therapy for Emphysema?

Low FIO2 (0.24 to 0.28) or 1 to 2 lpm nasal cannula.

What defines Chronic Bronchitis?

Severe dyspnea

History of smoking

Productive cough for 25% of the year (correct)

Non-productive cough

What is often the primary test for Bronchiectasis?

Bronchogram. Signup and view all the answers

What therapy is indicated for OSA if obstructive?

Nocturnal nasal or full-face CPAP or BiPAP. Signup and view all the answers

The cessation of breathing during sleep is defined as Asthma.

False Signup and view all the answers

What can be watched for in patients with Status Asthmaticus?

Progression to mechanical ventilation. Signup and view all the answers

What is a characteristic symptom of Myasthenia Gravis at LEVEL I?

Droopy facial muscles Signup and view all the answers

What is the important priority in treating a Drug Overdose?

Intubation. Signup and view all the answers

What is an indicator of Chest Trauma?

Sharp chest pain Signup and view all the answers

The usual treatment for a Hemothorax is the insertion of _____ tubes.

chest Signup and view all the answers

What condition is monitored after Abdominal Surgery?

Ventilatory volumes Signup and view all the answers

Pneumothorax requires chest tube placement for baseline improvement.

True Signup and view all the answers

What is the initial goal for incentive spirometry (IS) after surgery?

1/2 of the preoperative inspiratory capacity value. Signup and view all the answers

Which of the following can result in Acute Respiratory Distress Syndrome (ARDS)?

All of the above Signup and view all the answers

What is an appropriate initial ventilator setting for a patient described as having ARDS?

PEEP of at least 10. Signup and view all the answers

What type of surgery is performed to address cancer of the larynx?

Laryngectomy Signup and view all the answers

Mechanical ventilation through the laryngectomy tube is not allowed.

False Signup and view all the answers

What is a common symptom in a patient with Guillain-Barre syndrome?

Muscle paralysis. Signup and view all the answers

What symptom may indicate a patient is in shock?

Cold, clammy skin Signup and view all the answers

___ is a treatment that may involve administering diuretics for pulmonary edema.

Furosemide (Lasix) Signup and view all the answers

What is the best diagnostic test for congenital heart defects?

Echocardiogram Signup and view all the answers

What is the presentation of a pre-term infant with SIDS?

General respiratory distress. Signup and view all the answers

Laryngotracheobronchitis is otherwise known as ___.

Croup Signup and view all the answers

Croup is caused by bacterial infections.

False Signup and view all the answers

What is Acute Epiglottitis?

Condition where the epiglottis and adjacent upper airway tissues are infected with a bacteria causing inflammation and commonly threatening airway patency. Signup and view all the answers

What are the common symptoms associated with Acute Epiglottitis in children aged 3 to 10 years? (Select all that apply)

Tachypnea Signup and view all the answers

Intubation is usually required immediately for Acute Epiglottitis.

True Signup and view all the answers

Which of the following are treatments for Bronchiolitis / RSV? (Select all that apply)

Oxygen therapy Signup and view all the answers

What indicates the need for tracheostomy in case of Acute Epiglottitis? (Select all that apply)

Severe stridor Signup and view all the answers

Cystic Fibrosis is an inherited disorder resulting in the mass production of ____ mucus in the lungs.

thick Signup and view all the answers

Which test can show increased sweat chloride levels in Cystic Fibrosis?

Sweat Chloride Test Signup and view all the answers

What is a common result from exposure to cold in potential hypothermia cases? (Select all that apply)

Bradycardia Signup and view all the answers

Breath sounds may indicate respiratory distress in cases of burn trauma or carbon monoxide poisoning.

True Signup and view all the answers

Which medication should be avoided in cases of kerosene ingestion? (Select all that apply)

Inducing vomiting Signup and view all the answers

What is the primary treatment for Foreign Body Aspiration in the lungs?

Bronchoscopy Signup and view all the answers

AIDS is a disease of the immune system that commonly results in ______ carinii pneumonia.

pneumocystis Signup and view all the answers

What are common symptoms of Poison Inhalation/Ingestion? (Select all that apply)

Drowsiness Signup and view all the answers

Chest x-rays are not useful in diagnosing conditions related to burn trauma.

False Signup and view all the answers

How should activated charcoal be administered in case of poison ingestion?

Given at 10 x the suspected amount of the poison ingestion mixed with water—given orally. Signup and view all the answers

What is the associated condition with tachycardia?

Hypoxemia Signup and view all the answers

What is the procedure associated with cold, clammy skin?

Give oxygen and do ECG Signup and view all the answers

What treatment is indicated for suddenly short of breath?

Give 100% oxygen, V/Q scan, anticoagulants Signup and view all the answers

What is a sign of a pneumothorax?

Sudden onset of tachypnea Signup and view all the answers

What pattern on X-ray is associated with respiratory distress syndrome?

Butterfly pattern Signup and view all the answers

What should be done for a patient with cyanosis?

Give oxygen Signup and view all the answers

What is indicated for a patient who is lethargic and sleepy due to COPD O2 overdose?

Lower the oxygen Signup and view all the answers

What is the appropriate action for a patient showing signs of drug overdose?

Protect airway and possibly deliver Narcan if narcotic overdose. Signup and view all the answers

What treatment should be given for a severe asthma attack?

Give oxygen and bronchodilators Signup and view all the answers

Study Notes

Emphysema

Characterized by destruction of alveoli, loss of elasticity, and symptoms such as cyanosis, barrel chest, and digital clubbing.
Commonly associated with significant smoking history and occupational exposure.
Diagnostic findings include flattened diaphragms on chest X-ray, polycythemia, and compensated respiratory acidosis in ABGs.

Chronic Bronchitis

Defined by a productive cough occurring for 25% of the year for two consecutive years.
Symptoms include dyspnea and purulent sputum production, often linked to smoking and frequent infections.
PFT results reveal decreased airflow, especially in middle-sized airways.

Bronchiectasis

Abnormal dilation of bronchi with productive cough, often containing blood; presents with digital clubbing and recurrent infections.
Main diagnostic tool is a bronchogram showing a "tree in winter" pattern.
Sputum culture typically indicates gram-negative bacteria.

Obstructive Sleep Apnea (OSA)

Characterized by episodes of breathing cessation during sleep, often accompanied by snoring and daytime sleepiness.
Diagnosed via polysomnography, revealing either obstructive or central sleep apnea mechanisms.
Treatment options vary based on etiology, including CPAP for obstructive cases.

Asthma

Involves bronchial constriction leading to wheezing, dyspnea, and coughing.
Diagnostic findings may include respiratory acidosis on ABGs and hyperinflation on chest X-ray.
Management strategies incorporate bronchodilators, oxygen therapy, and inhaled steroids.

Status Asthmaticus

An acute exacerbation of asthma resistant to bronchodilators, characterized by severe dyspnea and wheezing.
As it may deteriorate rapidly, interventions include intubation and mechanical ventilation if necessary.

Myasthenia Gravis

Neuromuscular disorder causing muscle weakness, particularly ventilatory muscles; symptoms improve with rest and include ptosis and diplopia.
The Tensilon Challenge Test is vital for diagnosis and assessing crisis events.

Drug Overdose

Often presents with respiratory depression and requires immediate assessment of ventilatory drive.
Treatment typically involves airway protection, intubation if needed, and narcotic reversal with Narcan for opioid overdoses.

Neuromuscular Conditions

Include conditions like poliomyelitis and muscular dystrophy; may manifest as reduced respiratory volumes.
Monitor vital functions and intervene with positive pressure if ventilatory failure occurs.

Head Trauma

Assessment involves checking for signs of ICP and respiratory patterns.
Management may require monitoring ICP and safeguarding ventilation strategies.

Chest Trauma

Associated with pain, shallow breathing, and possible paradoxical movements if flail chest is present.
Treatment emphasizes supporting ventilation and addressing complications like pneumothorax through chest tube insertion.

Hemothorax/Pneumothorax

Signs include dyspnea, altered breath sounds, and changes observed on percussion.
Management usually entails chest tube placement, particularly for tension pneumothorax.

Thoracic Surgery

Requires careful monitoring of chest tube drainage and potential complications post-surgery.
Utilize techniques that promote lung expansion, like incentive spirometry, especially after lobectomy or pneumonectomy.

Neck/Spinal Injury

Presents with history of trauma and requires careful monitoring of ventilatory function.
Intubation techniques must consider potential spinal damage; modified jaw thrust is preferred.

Abdominal Surgery

Initial assessment should establish baselines for ventilatory function.
Post-operative care may include incentive spirometry to enhance pulmonary recovery.

ARDS (Acute Respiratory Distress Syndrome)

Characterized by decreased lung compliance and profound hypoxemia, often following significant lung insults.
Requires meticulous management of ventilatory pressures and PEEP adjustments to optimize oxygenation while protecting hemodynamics.### Ventilation Strategies
High ventilatory pressures may prompt consideration of alternate ventilation methods such as pressure control, high frequency, APRV, and inverse I:E ratios.
For patients with ARDS on ventilation, start with a PEEP of at least 10 cm H2O and pressure control ventilation as initial settings.

Laryngectomy Overview

Laryngectomy is performed to treat laryngeal cancer, with Level I involving surgical records indicating radical or simple procedures.
Post-operative complications may include airway obstruction due to bleeding within hours after surgery.

Decision Making Post-Laryngectomy

Monitor for complications such as blood clots in the laryngeal tube and be prepared for mechanical ventilation via the laryngectomy tube.
Radical laryngectomy results in a permanent tracheostomy; simple laryngectomy requires tube replacement in 3 to 6 weeks.
Prevent aspiration and delay oral ingestion for one week post-surgery.

Guillain-Barré Syndrome Information Gathering

History may show recent influenza-like illness, with symptoms including muscle paralysis starting in legs and progressing.
Pulmonary testing reveals decreased vital capacity and impending ventilatory failure; spinal tap indicates increased protein in spinal fluid.

Decision Making for Guillain-Barré

Vigilantly monitor for ventilatory muscle deterioration; only initiate mechanical ventilation when VC falls below 1.0 L.
Use anticoagulants and therapies like plasmapheresis and immunosuppressors to manage symptoms and prevent complications.

Shock Recognition

Identify shock through signs of massive trauma or hypothermia; patients may appear cold and clammy, with tachycardia and hypotension.
ABGs may show hypoxemia; hemodynamic values like CVP and cardiac output will be reduced.

Managing Shock

Administer oxygen immediately upon suspicion of shock; appropriate fluid resuscitation may be necessary.
Main treatment involves addressing the underlying cause of the shock.

Cardiac Surgery Overview

Conduct thorough preoperative assessment including vital signs and family history, with spirometry to establish baseline function.
ABGs are crucial for preoperative evaluations.

Decision Making for Cardiac Surgery

Be prepared for immediate CPR if necessary; perform incentive spirometry hourly to enhance lung function post-surgery.
Utilize ventilatory aids for unconscious patients, and remain vigilant for potential cardiac arrest.

Pulmonary Edema/CHF Information Gathering

Look for historical indicators of CHF, presenting symptoms include tachycardia and pink frothy secretions.
ABGs may reveal moderate to severe hypoxemia, with chest X-ray showing characteristic "Butterfly pattern."

Managing Pulmonary Edema/CHF

Act immediately, administering 100% oxygen and diuretics; treat underlying cardiac issues if identified.
Be ready for mechanical ventilation in case of ventilatory failure.

Myocardial Infarction/Arrhythmia Overview

History showcases chest pain and signs of potential heart disease; tachycardia and nausea are common symptoms.
ABGs demonstrate hypoxemia; elevated cardiac enzymes signal heart muscle damage.

Decision Making for Myocardial Infarction/Arrhythmia

Provide emergency oxygen and address arrhythmias with appropriate medications, including defibrillation when necessary.
Administer therapeutic levels of oxygen early upon presentation of signs.

Pulmonary Emboli Information Gathering

Recent trauma or surgery history is critical; symptoms include chest pain and dyspnea, vital signs may show elevation.
ABGs indicate persistent hypoxemia; a V/Q scan reveals mismatches in ventilation and perfusion.

Managing Pulmonary Emboli

Initiate anticoagulant therapy and monitor coagulation parameters; administer 100% oxygen in emergencies.
Mechanical ventilation may be required for severe cases.

Sudden Infant Death Syndrome (SIDS) Overview

Infants may show signs of respiratory distress; common in pre-term births.
Signs include cyanosis during feeding and abnormal APGAR scores.

Managing SIDS

Promote lung maturity with surfactant therapy; use CPAP and oxygen supplementation.
Mechanically ventilate as needed using SIMV mode for infants.

Congenital Heart Defects Information Gathering

History may indicate pre-term birth with persistent cyanosis despite high FIO2.
Echocardiogram serves as the definitive diagnostic tool for heart defects.

Managing Congenital Heart Defects

Recognize and support until surgical intervention; maintain adequate PaO2.
Mechanical ventilation is essential when signs of ventilatory failure emerge.

Neonatal Diaphragmatic Hernia Overview

Presents with respiratory distress and mediastinal shift; absent breath sounds on the affected side.
Chest X-ray typically shows displaced intestinal parts.

Decision Making for Diaphragmatic Hernia

Surgical intervention is required; use low ventilatory pressures and avoid manual resuscitation if possible.
Decompress the stomach and intestines with gastric tubes as needed.

Choanal Atresia Overview

Infants may present with normal appearance but show cyanosis during feeding.
Diagnosis confirmed by inability to pass a suction catheter through the nares.

Managing Choanal Atresia

Care during feeding is critical; surgical correction is necessary; keep ventilatory pressure low.

Laryngotracheobronchitis (Croup) Overview

Typically follows a recent cold; characterized by barking cough and stridor at rest in young children.
Lateral neck X-ray may show subglottic swelling.

Decision Making for Laryngotracheobronchitis

Priority is to administer oxygen and aerosolized racemic epinephrine.
Intubation is warranted if severe respiratory distress is present.

Acute Epiglottitis Overview

Rapid onset in children with drooling, hoarseness, and stridor; high fever is common.
X-ray shows inflammation in the supraglottic region.

Managing Acute Epiglottitis

Immediate airway establishment is critical; endotracheal intubation may be necessary in a surgical setting.
Antibiotic therapy is essential, along with maintaining oxygen therapy until inflammation subsides.

Bronchiolitis/RSV Information Gathering

Episodes of respiratory distress, wheezing, and recent illness in infants under 18 months are key indicators.
Chest X-ray often shows hyperlucency and scattered infiltrates.

Managing Bronchiolitis/RSV

Ribavirin treatment via SPAG unit is the primary intervention; ensure safe administration procedures are in place.

Cystic Fibrosis Overview

Characterized by thick mucus production; family history and significant sputum output are notable signs.
Chest X-ray resembles COPD, showing hyperinflation with a sweat test phenotype.

Managing Cystic Fibrosis

Regular monitoring of lung function is essential; therapies should aim to manage secretions and treat infections.### Secretion Removal Therapies
Primary treatment focuses on mobilizing and removing secretions.
Common therapies include:
- PEP therapy devices
- Chest physiotherapy with postural drainage
- Hydration devices: heated aerosol or ultrasonic nebulization
- Vibration therapy
- Oxygen therapy as needed
- Antibiotic therapy when infection occurs, often includes Tobramycin and Pulmozyme (Dornase alpha).

Hypothermia

Defined as significant body temperature drop due to cold exposure.
Level I symptoms include lethargy, bradycardia, and unconsciousness.
Level II: body temperature below 36°C.
Level IV: lateral neck x-ray may show "thumb sign" or pencil point sign.

Management of Hypothermia

Administer oxygen via heated aerosol at 40-100%.
Maintain resuscitation efforts until normal body temperature.
Monitor blood gas values, correcting for temperature discrepancies.

Burn Trauma / CO Poisoning

Result from fire or smoke exposure, affecting airway and blood oxygenation.
Level I focuses on history and visible signs like burns and "cherry-red" face.
Level IV indicates COHb levels of 20% or higher.

Management of Burn Trauma / CO Poisoning

Establish an artificial airway immediately if respiratory distress present.
Initiate 100% oxygen for CO poisoning without waiting for COHb results.
Continue oxygen therapy until COHb is below 10%.

Diabetes Management

Diabetes failure leads to respiratory ketoacidosis, presenting with Kussmaul's respirations.
Level I includes lethargy and significant alterations in respiratory patterns.
Level IV indicates blood glucose > 160 mg/dL.

Decision Making in Diabetes

Monitor for ventilatory failure and administer necessary electrolytes and fluids.
Correct ketoacidosis as part of the treatment plan.

AIDS & Pneumonia

AIDS results in pneumocystis carinii pneumonia; symptoms include weight loss and fever.
Use aerosolized Pentamadine for treatment and implement universal precautions.

Foreign Body Aspiration

Characterized by sudden onset cough, history of recent eating for adults.
Classify as partial obstruction with soft cough or complete obstruction with no sounds.

Management of Foreign Body Aspiration

Primary treatment is bronchoscopy to visualize and remove the foreign body.

Bronchopulmonary Dysplasia (BPD)

Related to prolonged mechanical ventilation, common in newborns with a history of IRDS.
Symptoms include wheezing and a chest x-ray showing chronic air trapping.

Treatment for BPD

Utilize bronchodilator therapy and keep FIO2 low, aiming for PaO2 of 55-65 mmHg.

Transient Tachypnea - Type II RDS

Occurs within 24-48 hours after birth, often in C-section deliveries.
Initial signs include cyanosis and increased respiratory distress.

Management of Transient Tachypnea

Supportive care for symptoms and oxygen therapy via oxyhood; CPAP for significant hypoxemia.

Infectious Pneumonia

High pulse rate and fever signify bacterial pneumonia; low-grade temperature indicates viral pneumonia.
Chest x-ray reveals lung consolidation and leukocyte changes depending on infection type.

Management of Infectious Pneumonia

Sputum cultures to identify the causative agent and appropriate antibiotics; mechanical ventilation if required.

Pickwickian Syndrome

Caused by obesity, characterized by obstructive sleep apnea.
Diagnosis confirmed through polysomnography.

Treatment for Pickwickian Syndrome

Use nasal nocturnal CPAP and support for weight loss.

Poison Inhalation/Ingestion

Symptoms differ by poison type; petroleum and kerosene poisoning lead to CNS depression.
Chest x-ray may show signs of pneumonitis or ARDS.

Decision Making in Poison Inhalation/Ingestion

Gastric lavage for specific substances; do not induce vomiting for kerosene or corrosive materials.
Administer activated charcoal for certain poisonings.

General Observations

Cold, clammy skin may indicate myocardial infarction; immediate oxygen and ECG advised.
Marked or severe symptoms require swift intervention.
Anxiety and confusion often signal hypoxemia; address underlying causes promptly.

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Description

Test your knowledge on the symptoms and therapies related to emphysema, chronic bronchitis, and obstructive sleep apnea (OSA). This quiz covers key definitions and important tests for respiratory conditions. Explore the link between various respiratory diseases and their management.