Dyspnea 1 & 2 Quiz

36 Questions | Total Attempts: 67

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Dyspnea 1 & 2 Quiz - Quiz

Questions from our small group sessions to help study for Cardio/Resp


Questions and Answers
  • 1. 
    A 27-year old male makes a minor transgression in a bar and a disgruntled patron plunges a knife into his left chest. Fortunately all vital structures are missed.  The lung is cut but seals when the knife is withdrawn.  There is little bleeding, however; there is a gaping hole in the chest wall that air can pass through.Which way does air move through the hole in the thorax immediately after the hole opens?
    • A. 

      The air moves out from the inward force from the chest wall

    • B. 

      The air moves in from the negative pressure between the chest wall and the lung

    • C. 

      The air moves out from the collapse of the lung

    • D. 

      The air moves in from the negative pressure in the lung

  • 2. 
    A 27-year old male makes a minor transgression in a bar and a disgruntled patron plunges a knife into his left chest. Fortunately all vital structures are missed.  The lung is cut but seals when the knife is withdrawn.  There is little bleeding, however; there is a gaping hole in the chest wall that air can pass through.Will the lung collapse?
    • A. 

      No. The tension from the pleural space will hold it in place.

    • B. 

      No. The outward recoil from the chest wall holds the lung inflated.

    • C. 

      Yes. The lung will collapse due to its elastic recoil.

  • 3. 
    A 27-year old male makes a minor transgression in a bar and a disgruntled patron plunges a knife into his left chest. Fortunately all vital structures are missed.  The lung is cut but seals when the knife is withdrawn.  There is little bleeding, however; there is a gaping hole in the chest wall that air can pass through.  Will the circumference of his chest increase or decrease?
    • A. 

      Increase because he is breathing heavily

    • B. 

      Increase because of the outward recoil of the chest wall

    • C. 

      Decrease because of the collapsed lung

    • D. 

      Decrease because he is taking shallow breaths

  • 4. 
    A 27-year old male makes a minor transgression in a bar and a disgruntled patron plunges a knife into his left chest. Fortunately all vital structures are missed.  The lung is cut but seals when the knife is withdrawn.  There is little bleeding, however; there is a gaping hole in the chest wall that air can pass through.  With this left sided injury, will his trachea move to the left or right?
    • A. 

      Left. The trachea shifts towards the side with more intrathoracic pressure.

    • B. 

      Left. The trachea shifts towards the side with less intrathoracic pressure

    • C. 

      Right. The trachea shifts towards the side with less intrathoracic pressure

    • D. 

      Right. The trachea shifts towards the side with more intrathoracic pressure

  • 5. 
    A 27-year old male makes a minor transgression in a bar and a disgruntled patron plunges a knife into his left chest. Fortunately all vital structures are missed.  The lung is cut but seals when the knife is withdrawn.  There is little bleeding, however; there is a gaping hole in the chest wall that air can pass through.  To treat him, you place an occlusive dressing over the wound on his left chest and position him on his side.  Would blood oxygen be highest if he were to lie on his left side or his right side?
    • A. 

      Left to improve circulation to the wounded side

    • B. 

      Left to improve perfusion to the side with ventilation

    • C. 

      Right to improve perfusion to the side with ventilation

    • D. 

      Right to improve circulation to the wounded side

  • 6. 
    A 27-year old male makes a minor transgression in a bar and a disgruntled patron plunges a knife into his left chest. Fortunately all vital structures are missed.  The lung is cut but seals when the knife is withdrawn.  There is little bleeding, however; there is a gaping hole in the chest wall that air can pass through.  Someone places one end of a tube into his left pleural space and makes an airtight seal.  The other end of the tube is placed into a pail of water on the floor with the tip 2cm below the surface.  Why?
    • A. 

      More than 2 cm of pressure wouldn't allow trapped air to escape

    • B. 

      The underwater seal prevents air from going back into the pleural space

    • C. 

      Bubbles are seen in the chamber when air is still escaping from the lung

    • D. 

      All of the above

  • 7. 
    A 45-year old female has episodic attacks of SOB, wheeze, and cough.  You make a diagnosis of asthma, a disease characterized by high airways resistance.  During the attack will the peak forced expiratory flow rate be increased or decreased?
    • A. 

      Increased due to high airways resistance

    • B. 

      Increased due to high pressure change

    • C. 

      Decreased due to high airways resistance

    • D. 

      Decreased due to high pressure change

  • 8. 
    A 45-year old female has episodic attacks of SOB, wheeze, and cough.  You make a diagnosis of asthma, a disease characterized by high airways resistance.  What will happen to inspiratory flow rates?
    • A. 

      Reduced more than expiratory flow

    • B. 

      Reduced less than expiratory flow

    • C. 

      Increased more than expiratory flow

    • D. 

      Increased less than expiratory flow

  • 9. 
    A 45-year old female has episodic attacks of SOB, wheeze, and cough.  You make a diagnosis of asthma, a disease characterized by high airways resistance.  Will the amount of gas in the chest at the end of expiration of each tidal breath (the FRC) increase or decrease?
    • A. 

      Increase

    • B. 

      Decrease

    • C. 

      Remain constant

    • D. 

      A and C

    • E. 

      B and C

  • 10. 
    A 45-year old female has episodic attacks of SOB, wheeze, and cough.  You make a diagnosis of asthma, a disease characterized by high airways resistance.  Will the amount of pleural pressure needed to make a tidal breath increase or decrease?
    • A. 

      Increase because of gas trapping

    • B. 

      Increase because of higher resistance

    • C. 

      Decrease because of higher resistance

    • D. 

      Decrease because of gas trapping

  • 11. 
    A 59-year-old male with scleroderma-associated pulmonary fibrosis comes to your office.  He has a chest x-ray that shows that hsi lung fields are more white than normal, indicating excessive scarring.  Would you expect his lung volumes to be larger or smaller than normal?
    • A. 

      Larger because of gas trapping

    • B. 

      Larger because of stiffened lung tissue

    • C. 

      Smaller because of reduced compliance

    • D. 

      Smaller because of less inward recoil

  • 12. 
    A 59-year-old male with scleroderma-associated pulmonary fibrosis comes to your office.  He has a chest x-ray that shows that hsi lung fields are more white than normal, indicating excessive scarring. Would you expect his flow rates to be greater or less than normal?
    • A. 

      Increased because of increased radial traction

    • B. 

      Increased because of use of accessory muscles

    • C. 

      Decreased because of less inward recoil

    • D. 

      Decreased because of reduced compliance

  • 13. 
    A 75-year-old woman develops the flu.  The virus destroys the lining (epithelial cell) of her lung and serum leaks into the airspaces.will the amount of gas in her chest increase or decrease?
    • A. 

      Increase because of gas trapping

    • B. 

      Increase because of increased compliance

    • C. 

      Decrease because of a loss of surfactant

    • D. 

      Decrease because of decreased compliance

  • 14. 
    A 75-year-old woman develops the flu.  The virus destroys the lining (epithelial cell) of her lung and serum leaks into the airspaces.  She is placed on a mechanical ventilator so that volume can be delivered to her lungs through a tube inserted into her trachea.  Suddenly, the pressure to obtain 500ml volume (breath) increases.  What is the possible cause?
    • A. 

      Increased resistance from a mucous plug

    • B. 

      Increased resistance from bronchospasm

    • C. 

      Increased resistance from a blocked tube

    • D. 

      Reduced compliance from a pneumothorax

    • E. 

      Reduced compliance from pulmonary edema

    • F. 

      All of the above

  • 15. 
    A 43-year-old woman was brought to the ER by a neighbour who found her unconscious.  the patient had been in good health but despondent over the last several days.  There was an empty pill bottle ont he table where she was found and a call to the pharmacist indicated that 30 tables of a sedative had been given to her one week before.  On physical examination she was unresponsive to verbal or painful stimuli and had no deep tendon reflexes.  BP 140/85, resp rate 6 and shallow, pulse 120.  ABG 7.12/72/30/25.  Calculate the A-a gradient during spontaneous respiration assuming a barometric pressure of 660 torr and R= 0.8
    • A. 

      10mmHg

    • B. 

      12mmHg

    • C. 

      20mmHg

    • D. 

      23mmHg

  • 16. 
    A 43-year-old woman was brought to the ER by a neighbour who found her unconscious.  the patient had been in good health but despondent over the last several days.  There was an empty pill bottle ont he table where she was found and a call to the pharmacist indicated that 30 tables of a sedative had been given to her one week before.  On physical examination she was unresponsive to verbal or painful stimuli and had no deep tendon reflexes.  BP 140/85, resp rate 6 and shallow, pulse 120.  ABG 7.12/72/30/25....mechanical ventilation with RA 7.37/40/73/25. Describe the mechanism of her hypoxemia.
    • A. 

      V/Q mismatch

    • B. 

      Hypoventilation

    • C. 

      Low inspired oxygen (FiO2)

    • D. 

      Pure shunt

    • E. 

      Diffusion defect

  • 17. 
    51-year-old lady has been noted by her family physician to be increasingly somnolent, irritable, gaining weight and has massive swelling of her legs.  She had smoked two packsof cigarettes a day for many years.  ABG on admission to the to the ICU: 7.36/64/26/34 on room air, and 7.34/66/95/34 on 35% O2.  6 weeks later: 7.40/44/65/26.  Calculate the A-a gradient breathing room air now and 6 weeks later.
    • A. 

      Now: 24, six weeks later 10

    • B. 

      Now: 10, six weeks later 24

    • C. 

      Now: 26, six weeks later 12

  • 18. 
    51-year-old lady has been noted by her family physician to be increasingly somnolent, irritable, gaining weight and has massive swelling of her legs.  She had smoked two packsof cigarettes a day for many years.  ABG on admission to the to the ICU: 7.36/64/26/34 on room air, and 7.34/66/95/34 on 35% O2.  6 weeks later: 7.40/44/65/26.  What is the mechanism for hypoxemia on admission?
    • A. 

      Low inspired oxygen (FiO2)

    • B. 

      Hypoventilation

    • C. 

      V/Q mismatch

    • D. 

      Pure shunt

    • E. 

      Diffusion defect

    • F. 

      B and C

    • G. 

      B and D

  • 19. 
    51-year-old lady has been noted by her family physician to be increasingly somnolent, irritable, gaining weight and has massive swelling of her legs.  She had smoked two packs of cigarettes a day for many years and is obese.  ABG on admission to the to the ICU: 7.36/64/26/34 on room air, and 7.34/66/95/34 on 35% O2.  6 weeks later: 7.40/44/65/26.  What are the factors that contributed to her high CO2?
    • A. 

      COPD

    • B. 

      Chest wall restriction from obesity

    • C. 

      Sleep apnea

    • D. 

      All of the above

  • 20. 
    51-year-old lady has been noted by her family physician to be increasingly somnolent, irritable, gaining weight and has massive swelling of her legs.  She had smoked two packsof cigarettes a day for many years and is obese.  ABG on admission to the to the ICU: 7.36/64/26/34 on room air, and 7.34/66/95/34 on 35% O2.  6 weeks later: 7.40/44/65/26.  When the patient was placed on supplemental O2 (35%), the CO2 increased.  Why would this happen?
    • A. 

      High O2 depresses ventilatory drive in patients with severe lung disease

    • B. 

      Hypoxic vasoconstriction creates more dead space

    • C. 

      Increasing the amount of oxygen in the blood decreases the amount of Hb free for CO2

    • D. 

      All of the above

  • 21. 
    A 27-year-old white male was seen in the office because of breathlessness on exertion for several weeks.  He owns 2 cockatiels and noted symptoms shortly after purchasing them.  His chest x-ray revealed a diffuse increase in the interstitial markings throughout both lungs.  ABG at rest on room air: 7.41/36/64, on 100% O2: 7.39/40/500, on exercise and room air: 7.56/24/38.  What is the physiologic mechanism of his hypoxemia? (check all that may apply)
    • A. 

      Low inspired oxygen

    • B. 

      Hypoventilation

    • C. 

      V/Q mismatch

    • D. 

      Pure shunt

    • E. 

      Diffusion defect

  • 22. 
    A 64-year-old male has been admitted for evaluation of genito-urinary symptoms and a recent GI hemorrhage.  2 days after admission he required a urinary catheter to permit bladder drainage.  on his 5 hospital day he developed a shaking chill and his arterial blood pressure decreased to 80/60.  At that time, the following lab data was obtained: Hb 80, ABG 7.32/30/50 SaO2 75%, lactate 7, blood cultures grew e.coli, JVP 2cm below right atrium, temperature 39.  You do a CXR and find that there is diffuse patchy airspace disease consistent with ARDS (acute respiratory distress syndrome).  Why does he have a low JVP?
    • A. 

      Widely dilated vascular bed due to sepsis

    • B. 

      Hypovolemia

    • C. 

      Heart failure

    • D. 

      A and B

  • 23. 
    A 64-year-old male has been admitted for evaluation of genito-urinary symptoms and a recent GI hemorrhage.  2 days after admission he required a urinary catheter to permit bladder drainage.  on his 5 hospital day he developed a shaking chill and his arterial blood pressure decreased to 80/60.  At that time, the following lab data was obtained: Hb 80, ABG 7.32/30/50 SaO2 75%, lactate 7, blood cultures grew e.coli, JVP 2cm below right atrium, temperature 39.  You do a CXR and find that there is diffuse patchy airspace disease consistent with ARDS (acute respiratory distress syndrome).  Assuming a cardiac output of 3.5L/min, calculate the delivery of oxygen to his vital organs
    • A. 

      523mlO2/min

    • B. 

      364mlO2/min

    • C. 

      287ml O2/min

    • D. 

      ???

  • 24. 
    A 64-year-old male has been admitted for evaluation of genito-urinary symptoms and a recent GI hemorrhage.  2 days after admission he required a urinary catheter to permit bladder drainage.  on his 5 hospital day he developed a shaking chill and his arterial blood pressure decreased to 80/60.  At that time, the following lab data was obtained: Hb 80, ABG 7.32/30/50 SaO2 75%, lactate 7, blood cultures grew e.coli, JVP 2cm below right atrium, temperature 39.  You do a CXR and find that there is diffuse patchy airspace disease consistent with ARDS (acute respiratory distress syndrome).  What approaches might be taken to improve tissue oxygen delivery?
    • A. 

      Blood transfusion to increase Hb

    • B. 

      Medicate to increase cardiac output

    • C. 

      Give him oxygen to increase O2 saturation

    • D. 

      Shift O2 dissociation curve to the left to carry more O2 (lower temp, correct acidosis)

    • E. 

      All of the above

  • 25. 
    30 year old HIV positive male comes to ER for a 3-week history of increasing SOB, non-productive cough, fevers and night sweats.  CXR shows diffuse interstitial disease.  Physical exam reveals mottled extremities and his oropharynx appears blue.  Resp rate is 30/min.  What is the cause for his mottled hands and blue oropharynx?
    • A. 

      Central cyanosis

    • B. 

      Desaturated Hb because of hypoxemia

    • C. 

      Desaturated Hb becasue of chronic respiratory acidosis (curve shifting)

    • D. 

      All of the above

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