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250 terms

Egan's Fundamentails of Respiratory Care Part 3

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?
Which of the following types of pneumonia suggests that the patient acquired it through inhalation of infectious particles?
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?
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?
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?
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?
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?
What is the drug of choice for the patient with Pneumocystis jiroveci pneumonia?
If an HIV-infected patient has an adverse reaction to the treatment of choice for Pneumocystis jiroveci pneumonia, what treatment should be instituted?
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?
Approximately how many individuals died of COPD in the United States in 2000?
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?
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?
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?
What lung disease is the most common current indication for lung transplantation?
Which of the following problems is associated with intravenous augmentation of synthetic a1-antitrypsin for the patient with genetic emphysema?
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%
Which of the following tests is recommended as part of the initial assessment of asthma?
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?
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?
What classification of drug would the leukotriene inhibitors fall under?
What b2-agonist is associated with 12 to 24 hours of bronchodilation?
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?
What treatment strategy is most controversial for a patient with asthma?
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)?
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
Chest radiographs will show hilar lymphadenopathy in most cases of asbestosis
The presence of pleural calcification on the chest film is consistent with what type of interstitial lung disease (ILD)?
Most patients with asbestosis have considerable asbestos exposure for many years before manifestation of the disease
Indicate the typical chest radiographic findings of a patient with silicosis.
apical nodules
Patients with simple pneumoconiosis of coal workers are often asymptomatic.
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.
What disease process is the most common cause of interstitial lung disease (ILD) in the United States?
Sarcoidosis is more common among young adults than is idiopathic pulmonary fibrosis (IPF).
Spontaneous remission rarely occurs with sarcoidosis.
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)?
A patient with which of the following diseases will have the longest life expectancy?
Most patients with cryptogenic organizing pneumonia (COP) will improve if given corticosteroid therapy.
Which of the interstitial lung diseases will in one third of patients cause a chylothorax?
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?
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?
Nephrotic syndrome causes pleural effusion by increasing oncotic pressure in the blood as a result of a protein leak into the urine.
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.
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)?
Which of the following conditions is most closely associated with exudative pleural effusion?
What is the most likely cause of a large unilateral pleural effusion in a 70 year old patient?
What type of pleural problem is most likely to develop from rupture of the thoracic duct?
What is the most common cause of a chylothorax?
What is the most common cause of hemothorax?
chest trauma
What is a common clinical finding even with small pleural effusions?
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.
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.
Chest tubes should be directed toward the base of the lung to evacuate a pneumothorax.
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?
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.
Death from massive pulmonary embolism is the result of cardiovascular collapse rather than respiratory failure.
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?
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?
What is the most common symptom in patients with pulmonary embolism?
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?
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.
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?
Most hospitalized patients who are immobile need prophylaxis for venous thromboembolism.
Which of the following medications would be standard therapy to treat acute deep venous thrombi?
What is the fastest way to achieve therapeutic levels of heparin in the treatment of acute deep venous thrombi?
follow established nomogram
What is the most commonly used oral anticoagulant?
A patient with pulmonary emboli has severe hypoxemia, acute right-sided heart failure, and shock. What treatment should be given at this time?
Primary pulmonary hypertension is more common in males than in females.
Which of the following physical examination findings is NOT found in patients with primary pulmonary hypertension?
digital clubbing
Which of the following radiographic findings is NOT typical for patients with primary pulmonary hypertension?
pleural effusion
What ECG finding is most often associated with right-sided heart failure and pulmonary hypertension?
right-axis deviation
What is the 5-year survival rate for patients with untreated idiopathic pulmonary artery hypertension (IPAH)?
Idiopathic pulmonary artery hypertension (IPAH) is often a fatal disease.
Which of the following treatments is least useful in the treatment of the patient with idiopathic pulmonary artery hypertension?
Why are calcium channel blockers NOT used in all patients with idiopathic pulmonary artery hypertension?
Only a small percentage of IPAH patients respond
What IV infusion has been found to improve exercise capacity, hemodynamic variables, and survival in patients with severe IPAH?
What type of drug is Bosentan?
Endothelin antagonists
Lung transplantation is an option in the management of idiopathic pulmonary artery hypertension.
In what type of IPAH patient is lung transplantation indicated?
Patients not responding to vasodilators with significant cardiac dysfunction
What therapy has been proven to improve survival in patients with COPD and pulmonary hypertension?
Which of the following risk factors for ARDS is considered a secondary risk factor?
Which of the following risk factors for ARDS is considered a secondary risk factor?
Which of the following mechanisms ultimately leads to ARDS regardless of the etiology?
disruption of the endothelial and epithelial barriers
Which of the following white blood cells is most commonly implicated in the inflammatory process of ARDS?
Which of the following organs plays a major role in induction and modulation of the systemic inflammatory response?
What time does the exudative phase of ARDS typically presents?
between days 1 and 3
Which of the following assessment tools is most useful in distinguishing ARDS from CHF?
Swan-Ganz catheter
Which of the following parameters is important in determining the optimal level of positive end-expiratory pressure (PEEP) in a patient with ARDS?
What is recommended in terms of fluid management of patients with ARDS?
The lungs of a patient with ARDS are effectively reduced to 20% to 30% of their normal size.
Which of the following benefits has not been associated with the use of PEEP in a patient with ARDS?
improved venous return
Which of the following complications has been associated with the use of PEEP in patients with ARDS?
reduced cardiac output
What mode of mechanical ventilation is designed to optimize ventilation by reducing alveolar collapse while using small tidal volumes in patients with ARDS?
high-frequency ventilation (HFV)
What is the maximal inspiratory pressure that should be targeted when using pressure control ventilation in patients with ARDS?
30 to 35 cm H2O
Which of the following statements is true about prone-positioning of patients with ARDS?
It produces a transient improvement in gas exchange.
The routine use of extracorporeal membrane oxygenation (ECMO) in the treatment of patients with ARDS is not recommended at this time.
What percentage of all cancer deaths are related to lung cancer?
about 30%
Approximately what percentage of all lung cancer is linked to smoking?
Other causes of lung cancer include all of the following EXCEPT which one?
microwave radiation
Which of the following is NOT a major histopathologic type of lung cancer?
ciliated cell carcinoma
What composition of adenocarcinoma best describes its histopathology?
glandular structures
Squamous cell carcinoma is composed of which of the following?
flattened stratified epithelial cells
Which of the following best describes the cell characteristics in small cell carcinoma?
develops from a common pulmonary stem cell
What type of histopathologic cells is associated with large-cell carcinoma?
pleomorphic cells
Which of the following is the most common type of lung cancer?
Which of the following is NOT associated with local tumor growth in the central airways?
fine crackles
What type of lung cancer usually is seen as a central lesion that may obstruct airways and lead to atelectasis?
squamous cell
On a chest radiograph, large-cell carcinoma is commonly seen as what type of lesion?
unilateral nodules
Apical growth may be associated with which of the following syndromes?
Which of the following organs is not commonly compromised in metastatic lung cancer?
The presence of headaches, vision changes, and neurologic symptoms is highly suggestive of metastasis.
What does the acronym TNM mean?
tumor, lymph node, metastases
Screening of patients at high risk for bronchogenic carcinoma with a chest radiograph has been found to increase survival.
Which bronchogenic carcinoma is staged as limited or extensive?
small cell
What is the treatment of choice for limited-stage small-cell lung cancer?
What is the most effective way to prevent lung cancer?
smoking prevention
Respiratory muscle weakness is associated with all of the following abnormalities except:
pulmonary embolism
The rapid, shallow breathing pattern seen in patients with neuromuscular disease is generally due to which of the following mechanisms?
frequent respiratory infections
Patients with poor inspiratory muscle function might show significant orthopnea and prefer to sleep in a prone position.
Expiratory muscle weakness is accompanied by a poor cough and secretion clearance.
Pulmonary function testing in patients with neuromuscular weakness would show normal values for which of the following?
diffusing capacity of the lungs (DLCO)
A decrease in forced expiratory volume in 1 second (FEV1) and vital capacity (VC) of greater than 20% when a patient moves from the seated to the supine position is suggestive of which of the following?
diaphragmatic muscle weakness
What respiratory dysfunction is commonly seen in myotonic dystrophy?
sleep-related disorders
In myasthenia gravis, which two pulmonary function values are the most sensitive in detecting respiratory muscle weakness?
PImax and PEmax
Peripheral nerve disorders that cause respiratory muscle dysfunction can be caused by all of the following except:
fluid imbalances
What is the mortality rate for Guillain-Barré syndrome?
low, less than 10%
How is diaphragmatic paralysis most often diagnosed?
pulmonary function testing
What is the approximate mean age of onset for amyotrophic lateral sclerosis?
56 years
What percentage of amyotrophic lateral sclerosis patients die within 5 years of diagnosis?
What is the hallmark finding of diaphragm paralysis?
abdominal paradox
What alteration in respiration is typically associated with stroke involving the cerebral cortex?
sleep apnea
Cobb angles are used to measure the severity in which disorder of the thoracic cage?
Which of the following is NOT a pulmonary complication frequently associated with flail chest?
aspiration pneumonia
The definition of sleep apnea uses what criteria for defining an episode of apnea?
10 seconds
What term is used to describe a significant decrease in airflow during sleep but not a complete cessation of breathing?
What are the criteria to define hypopnea?
30% decrease in airflow and 4% oxygen desaturation
What is the primary cause of obstructive sleep apnea?
small or unstable pharyngeal airway
What is believed to be the cause of systemic hypertension in patients with sleep apnea?
increased sympathetic tone
Which of the following factors has been shown to positively correlate with obstructive sleep apnea?
obesity of the upper body
Which of the following characteristics is not typically associated with sleep apnea?
Which of the following complaints is frequently seen in a patient with obstructive sleep apnea?
excessive daytime sleepiness
Which of the following physical exam findings is associated with obstructive sleep apnea?
large tonsils
Which of the following behavioral interventions is least useful for the treatment of sleep apnea?
avoidance of daytime naps
Why should the patient with obstructive sleep apnea not use alcohol?
Alcohol decreases the arousal threshold.
Which of the following medical therapies is considered first-line treatment for obstructive sleep apnea (OSA)?
continuous positive airway pressure (CPAP)
How does CPAP improve breathing in the patient with OSA?
pneumatic splinting of the upper airway
Patients with more severe levels of OSA usually need higher levels of CPAP to eliminate the apnea episodes.
What is considered to be the major problem with the use of CPAP in patients with obstructive sleep apnea?
patient compliance
What term is used to describe CPAP units that use a computer to adjust CPAP levels as needed by the patient during sleep?
Which of the following is NOT a common side effect of positive-pressure therapy?
Uvulopalatopharyngoplasty has a success rate of less than 50%.
Which of the following pulmonary function tests are frequently used to determine tolerance to resectional surgery?;
II. FEF25-75
I and IV
Which of the following factors are associated with a higher risk for ARDS?;
I. gastric aspiration
II. multiple transfusions
III. septic shock
IV. burn injury
I and III
Which of the following physical examination findings are consistent with the diagnosis of pulmonary embolism?;
I. congestive heart failure
II. inspiratory crackles on auscultation
III. loud P2
IV. tachypnea
II, III, and IV
Which of the following conditions contribute to the development of hypoxemia in
a patient with pulmonary emboli?;
I. cardiogenic shock
II. destruction of lung parenchyma
III. intrapulmonary shunt
IV. mc145-1.jpg mismatch
I, III, and IV
Which of the following conditions predispose a patient to venous thromboembolic disease?;
I. carcinoma
III. trauma
IV. thrombocytosis
I, III, and IV
Which of the following could be early warning signs that a pneumothorax is enlarging?;
I. decreased pulse oximetryt reading
II. development of a fever
III. increased respiratory rate
IV. mental confusion
I and III
What are the functions of a chest tube in a patient with chest trauma that causes bleeding and pneumothorax?;
I. to measure the rate of bleeding
II. to improve ventilation
III. to allow lung reexpansion
I, II, and III
Which of the following strategies is useful in the mechanical ventilation of a patient in status asthmaticus?;
I. allow peak inspiratory pressures to go as high as required
II. permissive hypercapnia
III. prolonged inspiratory time
IV. small tidal volumes
II and IV
Which of the following pulmonary function improvements have been associated with lung volume-reduction surgery (LVRS) in patients with emphysema?;
I. improved exercise endurance
II. improved FEV1
III. improved quality of life
IV. improved survival
I, III, and IV
Which of the following individuals should be immunized against influenza?;
I. 65-year-old individual
II. respiratory therapist
III. individual with chronic heart disease
IV. individual with glaucoma
I, II, and III
An intubated, mechanically ventilated patient is suspected of developing nosocomial pneumonia. The pulmonologist decides to perform a bronchoscopy. Which bronchoscopy findings would be consistent with pneumonia?;
I. alveolar collapse
II. distal purulent secretions
III. persistent secretions surging from distal bronchi during exhalation
IV. P/F ratio less than 50
II, III, and IV
Which of the following would interfere with the collection of a good sputum sample for Gram stain?;
I. contamination of the sample with oral secretions
II. lack of productive cough
III. prior antibiotic therapy
IV. rinsing with mouthwash prior to sputum collection
I, II, and III
Which of the following clinical conditions are often associated with a normal chest radiograph in the patient with pneumonia?;
I. dehydration
II. early infection
III. Klebsiella pneumonia
IV. Pneumocystis jiroveci infection
I, II, and IV