Phys Ii - Respiratory Pathophysiology

Front 1

obstructive pulmonary disorders are worse with ______

Back 1

expiration.

Front 2

All cases of obstructive pulmonary disorders have which common symptoms?

Back 2

dyspnea, "air hunger", wheezing

Front 3

FEV1 means what?

Back 3

forced expiratory volume in one second

Front 4

People with COPD have ____ work of breathing, mismatching of ______, and ____ FEV1

Back 4

increased work of breathing, mismatching of ventilation-perfusion, and decreased FEV1.

Front 5

Obstructive disorders inhibit ____

Back 5

exhalation (block air movement)

Front 6

Restrictive disorders inhibit ____

Back 6

muscular ventilation

Front 7

COPD consists of both ___ and ____

Back 7

chronic bronchitis and emphysema (usually patients have more severe one or the other)

Front 8

what is dyspnea?

Back 8

sensation of uncomfortable breathing

Front 9

Eupnea refers to what?

Back 9

Normal breathing

Front 10

___ is inadequate alveolar ventilation.

Back 10

Hypoventilation

Front 11

_____ is excessive alveolar ventilation.

Back 11

hyperventilation

Front 12

Hypoventilation causes ____ PaCO2, also known as ____

Back 12

increased, hypercapnia

Front 13

Hyperventilation causes _____ PaCO2, also known as ____

Back 13

decreased, hypocapnia

Front 14

What is hemoptysis?

Back 14

Coughing up of blood or bloody secretions

Front 15

An increase of bicarbonate results in _____ and a ___ pH level.

Back 15

alkalosis, high pH level

Front 16

An increase of CO2 buildup (as in hypoventilation) results in ___ and a ___ pH level.

Back 16

acidosis, low pH

Front 17

Clubbin is a result of ____

Back 17

prolonged/ chronic hypoxia

Front 18

Mild clubbing has an angle of ____ and advanced is ____

Back 18

180 deg, greater than 180

Front 19

Sneezing is a reflex to clear _____ respiratory passages

Back 19

upper

Front 20

Coughing is a reflex to clear -_____ respiratory passages

Back 20

lower

Front 21

What are the three main disorders with obstruction form conditions in the wall of the respiratory lumen?

Back 21

Asthma, acute bronchitis, chronic bronchitis

Front 22

Asthma is a chronic ____ disorder of the airways.

Back 22

inflammatory

Front 23

Asthmatic exacerbation is usually worse at ____ or ____.

Back 23

at night or early morning

Front 24

Chronic inflammation makes tissues ____ to antigents and results in asthma attacks.

Back 24

hyperresponsive

Front 25

Inflammation of the airways as in asthma causes _____ to percussion stimuli

Back 25

hyperresonance

Front 26

Asthmatic attacks cause _____ to constrict.

Back 26

bronchial smooth muscle

Front 27

What is the primary mediator of an asthma attack?

Back 27

IgE - activates allergic inflammatory response that initiates asthma attack.

Front 28

In asthma, airway mucus is ____.

Back 28

extremely thick

Front 29

Asthma resultsi in hyperinflation ____ to obstruction.

Back 29

distal

Front 30

In early asthma attach, ventilation/perfusion mismatch results in ___ with what type of changes?

Back 30

results in hypoxia. Symptoms include increased hyperventilation, drop in PaCO2, and increased pH (alkalosis)

Front 31

In later stages of an asthma attack, _____ leads to CO2 retention and respiratory acidosis.

Back 31

air trapping

Front 32

What are the two types of asthma attacks?

Back 32

1. prolonged, slow-onset over hours or days
2. hyperacute - develops in minutes to hours

Front 33

In an asthma attack, breath sounds are ___ with___

Back 33

decreased with wheezing.

Front 34

Acute bronchitis is what?

Back 34

acute infection or inflammation of the airways or bronchi

Front 35

What are major distinguishing features between acute bronchitis and pneumonia?

Back 35

Bronchitis has no pulmonary consolidation with normal CXR.

Front 36

What type of cough is typically presented with acute bronchitis?

Back 36

non-productive cough, aggrivated by cold, dry, and dusty conditions. In some cases, such as bacterial forms, a productive cough with fever may be present

Front 37

To be considered chronic bronchitis, cough and hypersecretion of mucus must continue for at least ___ months for ___ years

Back 37

3 months of the year for 2 consecutive years

Front 38

What factors may increase risk of chronic bronchitis?

Back 38

smoking, pollution,

Front 39

Inspired irritants ___ mucus production by ___ size and number of ____ in airway epithelium.

Back 39

1. increase mucus production
2. increasing size and number of
3. goblet cells

Front 40

In chronic bronchitis, why is the risk of bacterial infection higher?

Back 40

Mucus is thicker than normal and ciliary action is impaired

Front 41

Persistent inflammation and recurrent infection in chronic bronchitis leads to what?

Back 41

bronchospasm and permanent narrowing of airways

Front 42

What clinical manifestations would you anticipate in a patient with chronic bronchitis?

Back 42

1. excess body fluids
2. chronic cough
3. dyspnea on exertion
4. increased sputum
5. cyanosis (blue bloater)

Front 43

What is emphysema?

Back 43

abnormal permanent enlargement of acini accompanied by destruction of alveolar walls without obvious fibrosis

Front 44

_____ occurs in emphysema as a result of changes in lung tissue (as opposed to mucus and inflammation of other obstructive disorders)

Back 44

obstruction

Front 45

In emphysema, airflow is limted due to ___

Back 45

loss of elastic recoil.

Front 46

What is primary emphysema?

Back 46

an autosomal recessive disorder linked to deficiency of enzyme alpha-1-antitrypsin (rare)

Front 47

What is secondary emphysema?

Back 47

caused by inability of body to exhibit proteolytic enzymes in lungs due to inhaled toxins.

Front 48

In emphysema, ___ of alveoli occurs through breakdown of ____ within septa by proteases.

Back 48

1. destruction
2. elastin within septa

Front 49

In emphysema, expiration is difficult and hyper inflation results in ____ and ____

Back 49

bullae and blebs

Front 50

What are some clinical manifestations of emphysema?

Back 50

1. use of accessory muscles to breathe
2. pursed-lip breathing
3. minimal or absent cough
4. leaning forward to breathe (tripoding)
5. dyspnea on exertion

Front 51

In COPD, the disease state is characterized by _______.

Back 51

Airflow limitation that is not fully reversible.

Front 52

What muscles are considered the normal muscles of respiration? What are the accessory muscles?

Back 52

normal : diaphragm, external intercostals

accessory: INTERNAL intercostals, scalenes, etc.

Front 53

What 5 disorders result in obstruction of the airway lumen?

Back 53

1. bronchiectasis
2. bronchiolitis
3. acute tracheobronchial obstruction
4. epiglottitis
5. croup

Front 54

What are the three types of bronchiectasis? 1

Back 54

1. cylindrical
2. saccular
3. varicose

Front 55

What is bronchiectasis?

Back 55

persistent abnormal dilation of the bronchi, typically in conjucntion of other conditions and systemic disorders.

Front 56

What is cylindrical bronchiectasis?

Back 56

symmetrically dilated airways, most commonly after pneumonia

Front 57

What is saccular bronchiectasis?

Back 57

Bronchi become large and balloon like (one wall dilates)

Front 58

What is varicose bronchiectasis?

Back 58

constrictions and dilations deform the bronchi.

Front 59

What type of bronchiectasis is most reversible? Least reversible?

Back 59

most reversible - cylindrical
least reversible - varicose (not reversible)

Front 60

In varicose and saccular bronchiectasis, ___ divisions are ______with secretions or ____ by fibrosis.

Back 60

1. smaller divisions are
2. plugged with secretions or
3. obliterated by fibrosis.

Front 61

This disorder results in expectoration of cupfuls of purulent sputum.

Back 61

Bronchiectasis

Front 62

___ is inflammatory obstruction of small airways called ___

Back 62

Bronchiolitis; bronchioles

Front 63

Bronchiolitis is most common in ____.

Back 63

children and adults with chronic bronchitis

Front 64

Distal to the lesions in bronchiolitis, ___ of alveoli may occur.

Back 64

Atelectasis

Front 65

Decrease in ventilation/perfusion ration creates ___ _and ___ retention

Back 65

1. hypoxemia
2. CO2 retention

Front 66

The conduction zone of the respiratory tract main function is to ___

Back 66

move air in and out (bronchioles are at the end of that)

Front 67

The respiratory zone of the respiratory tract has what main purpose?

Back 67

air/blood gas exchange.

Front 68

Blockage of the trachea or bronchi is called what?

Back 68

acute tracheobronchial obstruction

Front 69

What may cause Acute tracheobronchial obstruction?

Back 69

aspiration of foreign body, malpositioned ETT, laryngospasm, epiglottitis, trauma, etc.

Front 70

Which lung is more often affected by acute tracheobronchial obstruction?

Back 70

right

Front 71

Is acute tracheobronchitis partial or complete?

Back 71

Could be either

Front 72

A severe, rapidly progressing infection of the epiglottis is called?

Back 72

Epiglottitis

Front 73

Epiglottitis is commonly found among___

Back 73

chidren ages 2-6

Front 74

What are symptoms of epiglottitis?

Back 74

high fever, sore throat, inspiratory stridor, respiratory distress, drooling, etc.

Front 75

What are major pathogens that cause epiglotitis

Back 75

historically H. Influenca b; now also seen in strep A, B, C, and G; viral pathogens, candida, streptococcus pneumoniae

Front 76

what is the common name for "acute laryngotracheobronchitis"?

Back 76

Croup syndrome.

Front 77

Croup syndrome is caused by ____ from infection.

Back 77

subglottic edema.

Front 78

Croup results in ____ airflow resistance/

Back 78

Increased

Front 79

A disorder that begins with rhinorrhea, and develops into sore throat, low-grade fever, and a seal-like cough is what???

Back 79

Croup Syndrome

Front 80

What is ARDS?

Back 80

Acute Respiratory Distress Sydnrome.

Front 81

What may cause ARDS?

Back 81

oxygen toxicity, radiation, infection, acidosis, etc etc. Respiratory membrane between alveoli and capillaries got destroyed either by toxin or immune system.

Front 82

Acute inflammation of the lung and diffuse alveolocapillary injury suggests ____.

Back 82

ARDS

Front 83

After diagnosis with ARDS, it takes survivors almost how long to recover to normal lung function

Back 83

1 year

Front 84

Disorders that cause ARDS acutely injure the ______ and cause severe pulmonary edema

Back 84

alveolocapillary membrane

Front 85

What is a common pathway for injury that triggers ARDS?

Back 85

Common pathway is massive inflammatory response by lungs.

Front 86

In ARDS, initial injury damages ____ epithelium and leads to ___ activation and ______.

Back 86

1. capillary endothelium
2. neutrophil activation
3. inflammatory cascade

Front 87

Neutrophils play a central roll in what respiratory disorder?

Back 87

ARDS

Front 88

What is considered the "Hallmark" of ARDS?!

Back 88

Inreased capillary permeability

Front 89

In ARDS, increased capillary permeability results in what 3 things?

Back 89

1. allowance of fluids, proteins, and blood to leak into interstitium and alveoli
2. edema and hemorrhage severely reducing compliance and impairing alveolar ventilation
3. chemical mediators cause pulm. vasoconstricton which leads to pulmonary HTN

Front 90

What are the two types of alveolar cells?

Back 90

1. "bulk" - simple squamous. This is where gas exchange occurs.

2. "Great" alvolar cells (cuboidal, produces surfactant, etc)

Front 91

In ARDS, type ___ alveolar cells are replaced with ___ because they are ____. WHat is the problem with this?

Back 91

1. type 1 cells are replaced by
2. type two cells because they are
3. more resiliant.

Problem is that oxygen has hard time getting across thicker border.

Front 92

____ results in HTN that could result in in CHF.

Back 92

ARDS

Front 93

In what disorder is surfactant inactivated and production of surfactant impaired?

Back 93

ARDS

Front 94

What is the primary cell in ARDS development?

Back 94

neutrophils

Front 95

In ARDS fibrosis leads to decreased with more severe L to R shunting.

Back 95

Functional reserve capacity (FRC)

Front 96

What is IRDS?

Back 96

Infant respiratory distress syndrome.

Front 97

What disorder is foudn to be a hyaline membrane disease?

Back 97

IRDS.

Front 98

This disease has hemorrhagic pulmonary edema, patchy atelectasis, hyaline membrianes, all due to a lack of surfactant.

Back 98

IRDS

Front 99

60% of infants with ____ could be severe or even fatal.

Back 99

IRDS

Front 100

Why are infants born before 34 weeks so critical?

Back 100

one reason is because they don't have surfactant then

Front 101

IRDS patients must generate ____________ to maintain patent alveoli.

Back 101

High intrathoracic pressure to maintain patent alvoeli

Front 102

_____ causes a leak of fluid into alveoli caused by hyaline membrane formation.

Back 102

IRDS

Front 103

Tachypnea, rapid shallow breathing, diminished breath sounds, nasal flaring, hypotension, edema, and tachypnea are all signs of ____

Back 103

IRDS

Front 104

IRDS is a ___ damage to _____ and ____

Back 104

Progressive damage to basmenet membrane and respiratory epithelial cells.