AHN 572: Respiratory 2 exam questions with complete verified solutions latest release 2025

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 dis- tant mets Used for NSCLC Stage I-II benefit from surgery Stage IIIb-IV do not benefit from surgery Two categories of SCLC? PFT in Lung Cancer S/S of Lung Cancer Limited: tumor is limited to the unilateral hemithorax (30%) Extensive: Tumor extends beyond hemithorax 1. If FEV1 2L, then predicted post-op calculated FEV1 should be performed 2. Post-op FEV1 800ml associated with low incidence of perioperative complica- tions 3. Post-op FEV1 700ml considered high risk for complications 1. Anorexia, weight loss, or asthenia oc- curs 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- struction 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 as- sociated with asthenia and weight loss. 9. Brain metastases (10% in NSCLC, Paraneoplastic syndromes: Treatment: Non-Small Cell Lung Carci- noma Endothelin receptor antagonist for pul- monary HTN... contraindicated in preg- nancy? True or False? more common in adenocarcinoma, and 20-30% in SCLC) may present with headache, nausea, vomiting, seizures, dizziness, or altered mental status. 1. Occur in 10-20% of lung cancer pa- tients 2. small cell carcinoma, SIADH can de- velop in 10-15% 3. squamous cell carcinoma, hypercal- cemia in 10% 4. Digital clubbing is seen in up to 20% of patients at diagnosis 5. Other common paraneoplastic syn- dromes include increased ACTH produc- tion, anemia, hypercoagulability, periph- eral neuropathy, and the Lambert-Eaton myasthenic syndrome Stage I, II patients: treated with surgical resection where possible Stage II, and possibly a subset of stage IB, are additionally recommended to re- ceive adjuvant chemotherapy. Stage IIIA patients have poor outcomes when treated with resection alone. Stage IIIB patients treated with concur- rent chemotherapy and radiation therapy have improved survival. Stage IV patients are treated with chemotherapy or symptom-based pallia- tive therapy, or both. True... teratogen Salicylate toxicity would cause what two acid/base abnoramlities. (hint one is res- piratory and one is metabolic) Pregnancy often causes what acid/base imbalance? Warfarin for PE... when can you discon- tinue the heparin bridge? How long are they on Warfarin? ALI or ARDS? (4) A high AG metabolic acidosis and a res- piratory alkalosis b/c it stimulates the medullary chemoreceptors Respiratory Alkylosis 1. Therapeutic INR of 2-3 for 2-3 days 2. 3-6 months for initial PE, 6-12 months for recurrent. 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 Primary and Secondary Causes of ARDS Define Primary versus Secondary Cause of ARDS Patho of ARDS: How interstitial and Alve- olar Edema Develops 1. Trauma 2. Infections 3. Shock 4. Near Drowning 5. Aspiration 6. Inhaled Toxins 7. Metabolic disorders 8. Hematologic disorders 9. Micro-atelectasis Primary: Direct insult to alveolar mem- branes Secondary: Cellular or humoral injury to capillary endothelium 1. Type 1 injury: Alveolar edema, atelec- tasis, and decreased lung compliance. Type 2 injury: decreased surfactant pro- duction. 2. Fluid shift b/t pulmonary capillaries and the alveoli. Concurrent vasoconstric- tion and mechanical vascular occlusion. Right to left shunting. Diagnostic Criteria of ARDS Primary S/S of ARDS? Associated factors of ARDS Most important tool in diagnosing ARDS? Indications for Mechanical Ventilation The Effects of PEEP in ARDS The Negative Effects of PEEP 3. Venous blood into the arterial circula- tion. Occurs across the pulmonary capil- lary bed. Caused by increasing atelecta- sis. Causes a V/Q ratio imbalance. 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 1. Severe dyspnea (usually patients chief complaint) 2. Tachypnea 3. Use of accessory muscles 4. Grunting 5. Hypotension 6. Diaphoresis 1. Hypoxemia 2. Hypocapnia 3. Respiratory alkalosis 4. Increased dead space ventilation, and reduced residual volume. Arterial oxygenation. PCO2 is usually not a good indicator 1. Respiratory Rate 34 2. PaCO2 45 (acute) 3. PaO2 60 with increasing levels of FiO2 4. Minute volume 12-15 L/ min 5. Forced vital capacity 20 mL/kg 1. Minimizes alveolar collapse 2. Restored functional residual capacity 3. Improves lung compliance 4. Decreases shunting 5. Promotes clearing of lung fields 1. Decreases Venous Retu