Egan's Fundamentails of Respiratory Care Part 3

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Test 3 review

Which of the following signs and symptoms is most closely associated with respiratory failure in a COPD patient?

changes in mental status

Which of the following signs associated with COPD is considered a late manifestation?

accessory muscle usage

Which of the following is true concerning pneumonia?

Pneumonia is the sixth leading cause of death in the United States.

A patient comes into the emergency department presenting with signs and symptoms of pneumonia. While taking the patient's history, it is determined that 2mc002-1.jpg months ago the patient spent 3 days in the hospital for acute angina. Since then the patient has been stable on medication. What type of pneumonia is this patient most likely to have?

HCAP

Which of the following types of pneumonia suggests that the patient acquired it through inhalation of infectious particles?

histoplasmosis

Which group of patients is most likely to develop pneumonia subsequent to large volume aspiration?

alcohol toxicity

Which of the following mechanisms is an uncommon route for the spread of pneumonia?

through the bloodstream

Which of the following types of pneumonia suggests that the patient acquired it because of the reactivation of a latent infection, often in the setting of immunosuppression?

cytomegalovirus

Which of the following represents an example of atypical community-acquired pneumonia?

Legionella pneumophila

In what percentage of patients with pneumonia has NO microbial agent been isolated?

up to 50%

What term is used to describe objects capable of transmitting infection through physical contact with them?

fomites

A patient presents with high fever, teeth-chattering chills, pleuritic pain, and a cough producing rust-colored sputum. What pathogen should be suspected?

Pneumococcal pneumoniae

Which of the following symptoms is typical for pneumococcal pneumonia?

pleuritic chest pain

A patient presents with pneumonia accompanied by foul-smelling breath, an absent gag reflex, or recent loss of consciousness. What should be suspected?

aspiration pneumonia

An elderly patient presents with failure to thrive, shortness of breath, confusion, and worsening congestive heart failure. What is most likely the patient's primary problem?

community-acquired pneumonia

What clinical finding should raise your suspicion that a patient has developed hospital acquired pneumonia?

a new fever

What finding is usually used to confirm the diagnosis of pneumonia?

new infiltrate on chest radiograph

What finding on the chest radiograph is typical for a viral pneumonia?

interstitial infiltrates

What type of severe lung infection may result in the development of small lung cavities called pneumatoceles?

Staphylococcus aureus

Rapidly spreading multilobar consolidation is typical for what type of pneumonia?

Legionella

What organism is associated with the highest mortality rate for patients with pneumonia?

Pseudomonas aeruginosa

Which of the following clinical findings is NOT associated with an increased risk of death in the patient with pneumonia?

respiratory alkalosis

What would be important to perform in order to obtain a good sputum sample that is to be used to detect the pathogen causing community-acquired pneumonia?

Patient should rinse mouth prior to sample collection.

Which of the following organisms have been found to colonize the oropharynx of healthy individuals?

Haemophilus influenzae

Which of the following organisms that cause pneumonia is most likely to result in a positive blood culture?

Haemophilus influenzae

What percent of patients with community-acquired pneumonia have a parapneumonic pleural effusion?

30% to 50%

A 35-year-old man is admitted to the hospital and has been confirmed to have pneumococcal pneumonia. What test would be wise to order at this time?

HIV

What diagnostic procedure might be done by a lone respiratory therapist in order to determine the presence of ventilator-associated pneumonia?

mini bronchoalveolar lavage

What timeline has been established to initiate antibiotic treatment in patients with pneumonia who are admitted to the hospital that will result in improved survival?

4 hours or less

For a patient with pneumonia with coexisting cardiopulmonary disease, according to the ATS guidelines, what single antibiotic could be given as empiric treatment?

intravenous fluoroquinolone

What antibiotic is the drug of choice for the patient with nonresistant S. pneumoniae?

penicillin

What is the drug of choice for the patient with Pneumocystis jiroveci pneumonia?

trimethoprim-sulfamethoxazole

If an HIV-infected patient has an adverse reaction to the treatment of choice for Pneumocystis jiroveci pneumonia, what treatment should be instituted?

pentamidine

What is an often-neglected but very important component of preventing transmission of pathogens between patients, particularly those who are ventilated?

hand washing

Would a patient being fed through a jejunostomy tube be more likely to develop nosocomial pneumonia than if he were fed totally via the parenteral route?

no, less likely

Which complaint is most closely associated with the diagnosis of chronic bronchitis?

chronic productive cough

Which form of COPD is most common?

chronic bronchitis

Where does COPD rank among the leading causes of death in the United States?

fourth

Approximately how many individuals died of COPD in the United States in 2000?

120,000

What is the approximate cost of COPD to the U.S. health system?

$32 billion

What is the leading risk factor for the development of COPD?

cigarette smoking

What percentage of all cases of COPD is caused by an a1-antitrypsin deficiency?

2% to 3%

What is the critical a1-antitrypsin level below which lung elastin is attacked and broken down?

80 mg/dl

Which airways are most susceptible to airway obstruction in patients with COPD?

small

Which of the following signs associated with COPD is considered a late manifestation?

accessory muscle usage

Which of the following signs and symptoms is most closely associated with respiratory failure in a COPD patient?

changes in mental status

It is not clear whether your patient has COPD or asthma. Which of the following characteristics is most closely associated with the diagnosis of asthma?

normalization of the FEV1 after use of a bronchodilator

Which of the following medications is generally only used if the patient still has debilitating symptoms from stable COPD, despite inhaled bronchodilator therapy?

methylxanthines

What is the benefit of pulmonary rehabilitation in patients with moderate to severe COPD?

exercise tolerance

What treatment for patients with COPD has been shown to improve long-term survival?

oxygen

What lung disease is the most common current indication for lung transplantation?

COPD

Which of the following problems is associated with intravenous augmentation of synthetic a1-antitrypsin for the patient with genetic emphysema?

expense

What pathophysiologic characteristic of asthma has been most recently emphasized in the description and subsequent treatment of this disease?

inflammation of the airways

What causes the degranulation of mast cells in asthma patients?

antigens attaching to IgE molecules on the mast cell surface

Which of the following symptoms is NOT a classic symptom of asthma?

chest pain

How much improvement is needed in the FEV1 after bronchodilator therapy before reversibility can be considered present in the patient with obstructive lung disease?

200 ml

A patient is admitted to the emergency department with an acute asthma exacerbation. Based on the following blood gas results, how severe is the asthma attack? pH 7.35, PaO2 58 mm Hg, PaCO2 46 mm Hg, HCO3- 18 mEq/L, SaO2 89%

severe

Which of the following tests is recommended as part of the initial assessment of asthma?

spirometry

What does the National Asthma Education Project (NAEP) recommend be measured at home in patients with moderate to severe asthma?

peak expiratory flow

An asthma patient's best effort produces a PEFR of 55% of personal best. What is indicated at this time?

Patient should probably seek medical attention now.

What medication is currently the most effective for the treatment of asthma?

corticosteroids

Which of the following side effects is associated with the use of inhaled corticosteroids?

oral candidiasis

What may be the drug of choice for managing atopic asthma in children?

cromolyn

What classification of drug would the leukotriene inhibitors fall under?

antiinflammatory

What b2-agonist is associated with 12 to 24 hours of bronchodilation?

salmeterol

Which medication is an anticholinergic bronchodilator?

ipratropium bromide

Which bronchodilator is commonly used in the hospital management of acute asthma exacerbation but is not the first-line bronchodilator?

ipratropium bromide

What medication would likely be the least often ordered during the emergency department management of an acute asthma attack?

methylxanthines

What treatment strategy is most controversial for a patient with asthma?

immunotherapy

What step must be taken to gain control of asthma in a patient that is experiencing frequent emergency department visits?

environmental control

Of the following common causes of asthma, which is the least likely to cause exercise-induced asthma?

swimming indoors

Which of the following has been identified as the most common cause of occupational asthma?

toluene diisocyanate

What etiologic factor is associated with the onset of nocturnal asthma?

aspiration of gastric acid at night

Which of the following asthma medications is not usually administered during pregnancy?

ipratropium bromide

Which group of disorders is categorized together because of similarities in their clinical presentations, plain chest radiographic appearance, and physiologic features?

interstitial lung diseases

What is the primary pathologic change that occurs in interstitial lung disease?

alveolar-capillary membrane structures replaced by fibrotic tissue

In interstitial lung disease, which of the following mechanisms does NOT contribute to impaired gas exchange?

depression of respiratory drive

What symptoms are most common in the patient with interstitial lung disease?

exertional dyspnea and nonproductive cough

Which of the following physical exam findings could be considered a late manifestation of interstitial lung disease (ILD)?

pulmonary hypertension

What radiographic technique has the ability to better define the specific parenchymal characteristics associated with specific types of interstitial lung disease?

high-resolution CT

What is the most common cause of interstitial lung disease (ILD)?

sarcoidosis

The classic chest radiographic findings in interstitial lung disease (ILD) are considered to be those caused by which of its component diseases?

idiopathic pulmonary fibrosis (IPF)

The development of interstitial lung disease (ILD) in a patient with emphysema can result in normal compliance measurements

true

Chest radiographs will show hilar lymphadenopathy in most cases of asbestosis

false

The presence of pleural calcification on the chest film is consistent with what type of interstitial lung disease (ILD)?

asbestosis

Most patients with asbestosis have considerable asbestos exposure for many years before manifestation of the disease

true

Indicate the typical chest radiographic findings of a patient with silicosis.

apical nodules

Patients with simple pneumoconiosis of coal workers are often asymptomatic.

true

A patient is exposed a second time to an antigen and subsequently seeks medical attention with sudden shortness of breath, chest pain, fever, chills, malaise, and a cough that may be productive of purulent sputum. What is the most likely cause of this pathology?

acute hypersensitivity pneumonitis

A patient is exposed a second time to an antigen and subsequently seeks medical attention with sudden shortness of breath, chest pain, fever, chills, malaise, and a cough that may be productive of purulent sputum. Which of the following is the most likely source of for the antigen?

hay field

The first line of treatment for patients with hypersensitivity pneumonitis is to avoid the offending agent.

true

What disease process is the most common cause of interstitial lung disease (ILD) in the United States?

sarcoidosis

Sarcoidosis is more common among young adults than is idiopathic pulmonary fibrosis (IPF).

true

Spontaneous remission rarely occurs with sarcoidosis.

false

What is the most common radiographic finding in the chest film of a patient with sarcoidosis?

bilateral hilar lymphadenopathy

What is the most common treatment for patients with idiopathic pulmonary fibrosis (IPF)?

prednisone

A patient with which of the following diseases will have the longest life expectancy?

sarcoidosis

Most patients with cryptogenic organizing pneumonia (COP) will improve if given corticosteroid therapy.

true

Which of the interstitial lung diseases will in one third of patients cause a chylothorax?

lymphangioleiomyomatosis

Which of the interstitial lung diseases is directly tied to exposure to first- and second-hand tobacco smoke?

pulmonary Langerhans cell histiocytosis (PLCH)

Which of the following medications has been shown to be useful in the treatment of almost all interstitial lung diseases?

oxygen

What treatment is recommended by the Centers for Disease Control and Prevention (CDC) guidelines for patients with interstitial lung disease (ILD)?

pneumococcal vaccine

What is the only therapy shown to prolong life in patients with end-stage, particularly fibrotic interstitial lung disease (ILD)?

lung transplantation

What use, other than prognostic value, can serial pulmonary function tests provide for the management of interstitial lung disease patients?

establish the need for lung transplantation

At what point is intrapleural pressure most negative?

inspiration

Nephrotic syndrome causes pleural effusion by increasing oncotic pressure in the blood as a result of a protein leak into the urine.

false

A patient with nephritic syndrome is noted to have a large right-sided pleural effusion and a small to medium-sized left-sided pleural effusion. What would explain this finding?

The nephrosis is complicated by pulmonary emboli.

What is the most common cause of pleural effusion that occurs due to lymphatic obstruction within the mediastinum?

cancer that has metastasized to the mediastinum

Most pleural effusions are transudative.

false

What is a common cause of persistent fever in intensive care unit (ICU) patients with pneumonia?

parapneumonic effusions

What is a common complication of pleurodynia (pleural pain)?

atelectasis

Which of the following conditions is most closely associated with exudative pleural effusion?

tuberculosis

What is the most likely cause of a large unilateral pleural effusion in a 70 year old patient?

malignancy

What type of pleural problem is most likely to develop from rupture of the thoracic duct?

chylothorax

What is the most common cause of a chylothorax?

malignancy

What is the most common cause of hemothorax?

chest trauma

What is a common clinical finding even with small pleural effusions?

dyspnea

What diagnostic procedure or technique is most commonly used to diagnosis the presence of a pleural effusion?

chest radiography

Which of the following is NOT a typical complication of thoracentesis?

rib fracture

Pleural effusions that occur secondarily to _____ are most often treated with pleurodesis.

malignancy

Describe a secondary spontaneous pneumothorax.

pneumothorax that results from underlying lung disease

Chest pain occurs in only a small percentage of patients with a pneumothorax.

false

Chest tubes should be directed toward the base of the lung to evacuate a pneumothorax.

false

In what age group is a primary spontaneous pneumothorax most commonly seen?

18 to 25 years

What underlying lung disease is most often present in a patient with secondary spontaneous pneumothorax?

chronic obstructive pulmonary disease (COPD)

Which of the following findings on a radiologic report would indicate the presence of a tension pneumothorax?

contralateral mediastinal shift, diaphragmatic depression, flattening of ribs

At what anatomic position should an 18-gauge IV catheter be placed to relieve a tension pneumothorax?

just superior to the second rib

What complication often occurs following rapid lung reexpansion due to the evacuation of air or fluid from the pleural space?

pulmonary edema

What is the primary tool used to diagnosis a pneumothorax?

chest radiography

If accurate sizing on a pneumothorax is desired, what diagnostic technique would be most appropriate?

computed tomography

When using a small-bore catheter with a one-way valve such as a Heimlich valve, how can you determine definitively that there is or is not a small air leak?

Connect to an underwater seal.

Approximately what percentage of patients who die from pulmonary embolism are NOT suspected before death?

70%

Which of the following risk factors is NOT associated with an increase in the incidence of pulmonary embolism?

positive smoking history

What percentage of patients with pulmonary embolism have pulmonary infarction as a complication?

less than 10%

Most pulmonary infarctions occur in the lung apexes.

false

Death from massive pulmonary embolism is the result of cardiovascular collapse rather than respiratory failure.

true

What is the main hemodynamic consequence of pulmonary emboli?

increased pulmonary vascular resistance

What percentage of the pulmonary vascular bed must be occluded by emboli before pulmonary hypertension occurs?

50%

What is the critical value for mean pulmonary arterial pressure, above which the right ventricle fails and death may ensue?

40 mm Hg

What is the most frequent symptom found in patients with confirmed pulmonary emboli?

dyspnea

What is the most common symptom in patients with pulmonary embolism?

dyspnea

What are the two most common findings on the electrocardiogram (ECG) in the patient with pulmonary embolism?

tachycardia and depressed ST segment

Which of the following arterial blood gas findings is seen in most patients with pulmonary embolism?

hypoxemia

Why is the D-dimer test not routinely performed on hospital inpatients suspected of having pulmonary emboli?

A high D-dimer only suggests the presence of comorbidities.

The presence of previous chronic obstructive pulmonary disease (COPD) reduces the diagnostic usefulness of mc155-1.jpg scans in acute pulmonary embolism.

false

In patients suspected of having pulmonary emboli in whom noninvasive studies do not give a definite diagnosis, what diagnostic procedure is the test of choice?

pulmonary angiography

Which of the following is true regarding the use of CT with contrast for diagnosing pulmonary embolism (PE)?

can only identify the medium to large PE

Which of the following medications should be used for in hospital prophylactic deep venous thrombosis therapy?

heparin

Most hospitalized patients who are immobile need prophylaxis for venous thromboembolism.

true

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