Obstructive diseases
What is the cause of barrel chest in obstructive diseases?
Air trapping
In the United States, the primary factor leading to the development of COPD is:
Smoking
History: 17 year old male student with 5th ER admission for acute SOB, cough with thick sputum.
Physical: Patient agitated and in distress severe wheezing and crackles on auscultation
ABG’s: pH 7.57, PaCO2 28 mmHg, PaO2 68 mmHg on 6 LPM nasal cannula
Lab: mucoid sputum contains plugs and spirals
WBC differential: high eosinophils
CXR: mild hyperinflation.
Which of the following is the most likely diagnosis?
Asthma
During the advanced stages of cystic fibrosis, the anatomic alterations cause the patient to have:
A. a primarily restrictive lung disease.
B. equal parts restrictive and obstructive lung disease.
C. a primarily obstructive lung disease.
D. normal airways with emphysema.
C. a primarily obstructive lung disease.
TRUE OR FALSE: If the bronchiectasis is primarily restrictive in nature, the patient will have a dull percussion note.
TRUE
A “pink puffer” refers to a patient with:
Emphysema
All of the following diseases are associated with mucus production except:
A. CF
B. Chronic Bronchitis
C. Emphysema
D. Bronchiectasis
C. Emphysema
Your 75 year old male patient has the following findings:
Inspection: Increased HR, RR, and BP, SpO2 88%, pursed lip breathing, barrel chested,
cyanotic, coughing up large amounts of foul sputum that settles into 3 layers of a 24-hr period
Palpation: Decreased tactile and vocal fremitus
Percussion: Hyperresonance
Auscultation: Crackles and Wheezing
These findings are consistent with:
Bronchiectasis
Which of the following signs and symptoms characterize Cystic Fibrosis?
1, 2, 4
If the bronchiectasis is primarily restrictive in nature, what will be seen on the CXR?
A. Atelectasis
B. Increased Opacity
C. Depressed diaphragms
D. Infiltrates
A, B and D
A “blue bloater” refers to a patient with:
Chronic Bronchitis
What ABG value would NOT be consistent with chronic ventilatory failure in COPD?
A. PaCO2 < 35 mmHg
B. PaCO2 > 45 mmHg
C. HCO3 > 26 mEq/L
A. PaCO2 < 35 mmHg
Your patient has the following findings:
Inspection: Stocky, overweight, peripheral edema, distended neck veins, productive cough with
purulent sputum, digital clubbing and cyanotic nail beds
Palpation: Normal
Percussion: Normal
Auscultation: Crackles and Wheezes
ABG: Chronic ventilatory failure with hypoxemia
DLCO: normal
These findings are consistent with:
Chronic Bronchitis
Cystic fibrosis patient can have all of the following except:
A. excessive, viscous pulmonary secretions
B. tendency for status asthmaticus
C. meconium ileus (bowel obstruction)
D. malnutrition
B. tendency for status asthmaticus
When bronchiectasis is primarily obstructive in nature, which of the following would you suspect upon assessment?
1. Pursed lip breathing
2.Decreased residual volume
3. Increased AP diameter
4. Increased opacity on CXR
1 and 3
What will happen to the RV and TLC with obstructive diseases?
They will both increase
Which of the following are used to confirm a diagnosis of COPD?
1. Presence of a chronic cough
2. Chronic exposure to environmental smoke
3. Sweat chloride test
4. Decreased FEV1 and FEV1%
1, 2, 4
Your 12 year old female patient has the following findings:
Inspection: HR 130, RR 28, accessory muscle use, pulsus paradoxus, cough with excessive
thick, white sputum
Palpation: Decreased tactile fremitus
Percussion: Hyperresonance
Auscultation: Expiratory wheezes
ABG: Acute alveolar hyperventilation with mild hypoxemia
PEFR: decreased
These findings are consistent with:
Asthma
Which of the following conditions is common in Cystic Fibrosis?
A. Spontaneous pneumothorax
B. Cardiogenic pulmonary edema
C. Pleural effusion
D. Congestive Heart failure
A. Spontaneous pneumothorax
How many layers does a pt with bronchiectasis sputum settle in?
3 layers
Which of the following would confirm the presence of an obstructive disease?
A. Decreased FEV1 and Decreased FEV1%
B. Increased FEV1 and Increased FEV1%
C. Decreased FEV1 and Increased FEV1%
D. Increased FEV1 and Decreased FEV1%
A. Decreased FEV1 and Decreased FEV1%
What is the cause of abnormal volumes and capacities in obstructive diseases?
Air trapping
Your patient has the following findings:
Inspection: Thin, barrel chested, using accessory muscles, pursed lip breathing
Palpation: Decreased tactile fremitus, and decreased chest expansion
Percussion: Hyperresonance
Auscultation: Diminished breath sounds with prolonged expiration
ABG: Chronic ventilatory failure with hypoxemia
DLCO: decreased
These findings are consistent with
Emphysema
Which of the following are commonly cultured from the mucus in the tracheobronchial tree of a
patient with cystic fibrosis?
1. Klebsiella pneumoniae
2. Pseudomonas aeruginosa
3. Haemophilus influenzae
4. Staphylococcus aureus
2, 3, 4
Give an example of an ABG for a patient who has severe bronchiectasis
Give an example of chronic respiratory acidosis