AHN 572: Respiratory 2 Questions and Answers latest update 2025
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AHN 572: Respiratory 2
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AHN 572: Respiratory 2
S/S of Lung Cancer - ️️1. Anorexia, weight loss, or asthenia occurs in 55-90%
2. Up to 60% have a new cough or a change in a chronic cough
3. 6-31% have hemoptysis
4. 25-40% complain of pain
5. change in voice (compromise of the recurrent laryngeal nerve)
6. superior vena cava syndrome (ob...
AHN 572: Respiratory 2
S/S of Lung Cancer - ✔️✔️1. Anorexia, weight loss, or asthenia occurs in 55-90%
2. Up to 60% have a new cough or a change in a chronic cough
3. 6-31% have hemoptysis
4. 25-40% complain of pain
5. change in voice (compromise of the recurrent laryngeal nerve)
6. superior vena cava syndrome (obstruction of the superior vena cava with
supraclavicular venous engorgement)
7. Horner syndrome (ipsilateral ptosis, miosis, and anhidrosis from involvement of the
inferior cervical ganglion and the paravertebral sympathetic chain).
8. Distant metastases to the liver are associated with asthenia and weight loss.
9. Brain metastases (10% in NSCLC, more common in adenocarcinoma, and 20-30% in
SCLC) may present with headache, nausea, vomiting, seizures, dizziness, or altered
mental status.
What is minute ventilation? - ✔️✔️Amount of air exchanged in 1 minute
I:E Ratio - ✔️✔️The ratio of inspiratory time to expiratory time during each ventilator
cycle.
A typical time ratio is one-third for inspiration, two-thirds for expiration
A typical I:E ratio? - ✔️✔️A typical time ratio is one-third for inspiration, two-thirds for
expiration
Causes of increase pulmonary vascular resistance - ✔️✔️1. vasoconstriction (e.g.
hyoxemia and or acidosis)
2. Loss of vasculature (e.g. emphysema and lung resection)
3. Occlusion of the pulmonary vasculature (PE)
4. Relative stenosis of the pulmonary vasculature
,Primary causes of increased pulmonary venous pressure? (3) - ✔️✔️1. Left ventricular
failure or hypertrophy
2. Valvular heart disease (e.g. mitral stenosis and aortic stenosis)
3. Constrictive pericarditis
Minute Ventilation Calculation - ✔️✔️TV x RR (L/min
Initial TV setting - ✔️✔️8-10 ml/kg ideal body weight
For every 10mmHg change in PCO2, the pH will change by _____. - ✔️✔️0.08
What is TNM? - ✔️✔️An international staging system.
T: describes tumor size and location
N: describes presence and location of nodal metastases
M: refers to presence or absence of distant mets
Used for NSCLC
Stage I-II benefit from surgery
Stage IIIb-IV do not benefit from surgery
Two categories of SCLC? - ✔️✔️Limited: tumor is limited to the unilateral hemithorax
(30%)
Extensive: Tumor extends beyond hemithorax
PFT in Lung Cancer - ✔️✔️1. If FEV1 < 2L, then predicted post-op calculated FEV1
should be performed
2. Post-op FEV1 >800ml associated with low incidence of perioperative complications
3. Post-op FEV1 <700ml considered high risk for complications
Paraneoplastic syndromes: - ✔️✔️1. Occur in 10-20% of lung cancer patients
2. small cell carcinoma, SIADH can develop in 10-15%
3. squamous cell carcinoma, hypercalcemia in 10%
4. Digital clubbing is seen in up to 20% of patients at diagnosis
5. Other common paraneoplastic syndromes include increased ACTH production,
anemia, hypercoagulability, peripheral neuropathy, and the Lambert-Eaton myasthenic
syndrome
Treatment: Non-Small Cell Lung Carcinoma - ✔️✔️Stage I, II patients: treated with
surgical resection where possible
Stage II, and possibly a subset of stage IB, are additionally recommended to receive
adjuvant chemotherapy.
Stage IIIA patients have poor outcomes when treated with resection alone.
, Stage IIIB patients treated with concurrent chemotherapy and radiation therapy have
improved survival.
Stage IV patients are treated with chemotherapy or symptom-based palliative therapy,
or both.
Endothelin receptor antagonist for pulmonary HTN... contraindicated in pregnancy?
True or False? - ✔️✔️True... teratogen
Salicylate toxicity would cause what two acid/base abnoramlities. (hint one is respiratory
and one is metabolic) - ✔️✔️A high AG metabolic acidosis and a respiratory alkalosis
b/c it stimulates the medullary chemoreceptors
Pregnancy often causes what acid/base imbalance? - ✔️✔️Respiratory Alkylosis
Warfarin for PE... when can you discontinue the heparin bridge? How long are they on
Warfarin? - ✔️✔️1. Therapeutic INR of 2-3 for 2-3 days
2. 3-6 months for initial PE, 6-12 months for recurrent.
ALI or ARDS? (4) - ✔️✔️1. Bilateral pulmonary infiltrates on chest x-ray
2. Pulmonary Capillary Wedge Pressure < 18 mmHg (2.4 kPa)
3. PaO2/FiO2 <300 mmHg (40 kPa) = ALI
4. PaO2/FiO2 <200 mmHg (26.7 kPa)= ARDS
Define Primary versus Secondary Cause of ARDS - ✔️✔️Primary: Direct insult to
alveolar membranes
Secondary: Cellular or humoral injury to capillary endothelium
Patho of ARDS: How interstitial and Alveolar Edema Develops - ✔️✔️1. Type 1 injury:
Alveolar edema, atelectasis, and decreased lung compliance. Type 2 injury: decreased
surfactant production.
2. Fluid shift b/t pulmonary capillaries and the alveoli. Concurrent vasoconstriction and
mechanical vascular occlusion. Right to left shunting.
3. Venous blood into the arterial circulation. Occurs across the pulmonary capillary bed.
Caused by increasing atelectasis. Causes a V/Q ratio imbalance.
Diagnostic Criteria of ARDS - ✔️✔️1. Predisposing condition
2. Diffuse, bilateral infiltrates on CXR
3. PCWP less than or equal to 18
4. No clinical evidence of CHF
5. PaO2/FiO2 less than or equal to 200mmHg
Primary S/S of ARDS? - ✔️✔️1. Severe dyspnea (usually patients chief complaint)
2. Tachypnea
3. Use of accessory muscles
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