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Pathophysiology > Chapter 27 - Alteration in Pulmonary Function > Flashcards

Chapter 27 - Alteration in Pulmonary Function Flashcards

1
Q

what is ventilation?

A

movement of air in and out of lungs

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2
Q

what is oxygenation?

A

loading O2 molecules onto hemoglobin

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3
Q

what is respiration?

A

O2 and CO2 exchange pf alveoli (external) & systemic capillaries (internal)

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4
Q

what is perfusion?

A

delivery of blood to a capillary bed in tissue

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5
Q

what dyspnea?

A

breathlessness

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6
Q

what are the signs of dyspnea?

A

flaring of nostrils, use of accessory muscles & head bobbing in children

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7
Q

what is paroxysmal nocturnal dyspnea?

A

wakes you gasping for breath in the middle of night

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8
Q

A color that provides info about progression of disease

A

sputum

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9
Q

what is hemoptysis?

A

coughing up of blood

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10
Q

what does coughing up of blood indicates?

A

infection or inflammation of bronchiole.

*if sever, it can indicate cancer

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11
Q

what is normal breathing?

A

eupnea

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12
Q

T or F: eupnea is rhythmic and effortless

A

True

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13
Q

Eupnea: occasionally the person takes a deeper ____ or a ____

A

breaths; sighs

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14
Q

what is the purpose of sighs?

A

helps to maintain normal breathing (1), twice tidal vol/ 10 times per hour (2) & equals out O2 consumption and CO2 expulsion

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15
Q

what is hyperpnea?

A

Kussmaul respiration occurs with strenuous exercise.

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16
Q

what happens during kussmaul respiration

A

increased ventilation rate & greatly increased tidal volume & no pause at end of expiration

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17
Q

what are some abnormal breathing patterns

A

cheyne-stokes respiration

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18
Q

what is Cheyne-Stokes respiration?

A

alternating deep/ shallow breathing (1)

includes periods of apnea (2), followed by increased volume ventilations.

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19
Q

what is apnea?

A

stopping breathing for 15-60 sec

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20
Q

what does cheyne-stokes cause?

A

reduced blood flow to brain/ reduced brain impulses to respiratory center

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21
Q

T or F: hypoventilation and hyperventilation can both determined by blood gases.

A

True

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22
Q

what is hypoventilation?

A

inadequate ventilation

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23
Q

what is the issue with hypoventilation?

A

CO2 removal doesn’t keep up with CO2 production

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24
Q

result of hypoventilation?

A

hypercapnia – increased CO2 in bloodstream

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25
Q

what is hyperventilation

A

alveolar ventilation exceeding needs.

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26
Q

what is the issue with hyperventilation?

A

removal of more CO2 than is produced

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27
Q

what is the result of hyperventilation

A

hypocapnia – reduced CO2 in blood stream

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28
Q

what is cyanosis

A

bluish discoloration of skin

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29
Q

cause of cyanosis?

A

develops when 5 grams of hemoglobin is desaturated

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30
Q

T or F: Cyanosis is evident until it is severe = insensitive indicator of respiratory failure.

A

False; not evident until it is severe

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31
Q

what are the two types of cyanosis

A

peripheral cyanosis & central cyanosis

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32
Q

what is peripheral cyanosis

A

poor circulation in fingers/toes due to peripheral vasoconstriction

best seen in nail beds

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33
Q

what is central cyanosis

A

decreased arterial oxidation (low PaO2) from pulmonary disease.

detected in buccal mucosa membranes and lips

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34
Q

what is clubbing?

A

bulbous formations at end of fingertips and toes.

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35
Q

what causes clubbing?

A

diseases that disrupt pulmonary circulation causing hypoxemia/ rarely reversible

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36
Q

pain from pulmonary disorder?

A

almost localized in chest wall (1)

can be pinpointed by unique sound called the pleural friction club (2)

often be reproduced by pressing on sternum or ribs (3)

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37
Q

what is pleural friction rub?

A

pleural walls rub together due to reduced fluid in pleural cavity

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38
Q

what is hypercapnia

A

increased Co2 in blood caused by hypoventilation of alveoli.

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39
Q

what does hypoventilation causes?

A

decreased drive to breath
depression of respiratory center
disease to medulla oblongata

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40
Q

what does hypoventilation result?

A

increased work of breathing

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41
Q

what is the effect of hyperventilation?

A

electrolyte (ionic) imbalances

dysrhythmia (irregular breathing rate)

severe = coma

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42
Q

Hypoventilation often overlooked as it can appear _____. Important to obtain blood ____ to confirm.

A

normal; gases

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43
Q

what does hypercapnia increased?

A

PaCO2

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44
Q

what is hypoxemia?

A

decreased PaCO2 in arterial blood

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45
Q

what are the two causes of hypoxemia?

A

issue with delivery of O2 to alveoli (ventilation) and delivery of blood to lung (perfusion) (1)

thickening of alveolar membrane or destruction of alveoli (2)

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46
Q

Diffusion of O2 from alveoli to blood dependent up two factors:
(1) amount of ____ entering _____ (ventilation = V)

(2) amount of blood ____ capillaries around alveoli (Q)

A

air; alveoli; perfusing

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47
Q

what is the most common cause of hypoxemia?

A

ab ventilation/perfusion ratio (V/Q)

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48
Q

what is the normal PaO2?

A

80-100 mmHg

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49
Q

what is the severe hypoxemia?

A

<40 mmHg

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50
Q

what is shunt?

A

normal perfusion; inadequate ventilation

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51
Q

what is alveolar dead space?

A

inadequate perfusion/ normal ventilation

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52
Q

what is acute respiratory failure?

A

inadequate gas exchange.

= potential complication of any major

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53
Q

what are some values of PaCO2, PaO and pH for acute respiratory failure?

A

PaO2 is less than 60 mmHg

PaCO2 is greater than 50

ph less than or equal to 7.25

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54
Q

what are the normal values of PaO2, PaCO2 & pH

A

PaO2 = 75-100 mmHg
PaCO2 = 35-45 mmHg

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54
Q

prevention for acute respiratory failure?

A

frequent turning and position changes; deep breathing exercise; early ambulation

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55
Q

what are the most common conditions for acutre respiratory failure?

A

pneumonia, edema and embolism

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56
Q

what is the cause of chest wall restrictions (CWR)

A
  • deformity/ obesity/ neuromuscular disease
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57
Q

result of CWR:

A

increased work of breathing/ usually decrease in tidal volume

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58
Q

when person has CWR, pain from injury, disease and surgery can cause _____

A

hypoventilation

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59
Q

Summary of CWR:
_____ tidal volume/ ____ breathing rate

can lead to ____ failure

A

decreased; increased; respiratory

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60
Q

type of CWR: what is flail chest?

A

fracture of consecutive ribs with/without sternum damage.

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61
Q

what is the result of flail chest?

A

chest wall instability = paradoxical movement of chest when breathing.

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62
Q

what are the two types of paradoxical breathing:

A

inspiration - unstable portion of chest wall moves inward

expiration – portion moves outward

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63
Q

what is the result of paradoxical breathing?

A

impaired ventilation of alveoli

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64
Q

what is pneumothorax

A

air/gas in pleural space

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65
Q

what is the cause of pneumothorax?

A

rupture to visceral pleural

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66
Q

result of pneumothorax

A

lungs tend to collapse

67
Q

what is pleural effusion

A

fluid in pleural space/ from blood or lymph

68
Q

how to diagnose pleural effusion

A

chest x-ray
thoracentesis (aka needle aspiration)

69
Q

what is empyema

A

infected pleural effusion by microorganisms.

70
Q

indication of empyema?

A

pus in pleural space

71
Q

what is the cause of empyema?

A

pulmonary lymphatic tissue becomes blocked which leads to contaminated lymphatic fluid moves into pleural space

72
Q

Empyema is the result of ____ or ______ construction

A

surgery; bronchial

73
Q

treatment for empyema?

A

antibiotics and drainage of pleural space with chest tube

74
Q

what does restrictive lung disease mean?

A

difficulty with inspiration – expanding lungs

75
Q

what does obstructive lung diseases mean?

A

difficulty with expiration

76
Q

RLD = characterized by ____ lung compliance = ____ work of breathing at tidal volume

A

decreased; increased

77
Q

Aspiration?

A

passage of fluids/solids into lungs

78
Q

cause of aspiration?

A

ab swallowing mechanisms/ cough reflex impaired –> can lead to pneumonia.

CNS or PNS ab

79
Q

treatment for aspiration

A

bronchoscopy

*failure to remove —> inflammation

80
Q

Atelectasis?

A

collapse of lung

81
Q

what are the two types of alveoli collapse?

A

compression atelectasis – caused by external pressure (1)

surfactant impairment – decreased production of surfactant (2)

82
Q

Atelectasis occur _____ surgery when using general _____

A

after; anaesthetic

83
Q

treatment for atelectasis?

A

deep breathing excercise promotes ciliary removal secretions

84
Q

Bronchiectasis?

A

peristent ab dilation of bronchi (large airways)

85
Q

what are the cause of obstruction?

A

inflammation due to mucus plugs (1)

chronic inflammation = destruction of elastic/muscular bronchi wall = permanent dilation (2)

86
Q

symptoms of bronchiectasis?

A

chronic productive cough

large amount of foul-smelling sputum

86
Q

Bronchiolitis obliterans = ____ of airways = scaring

A

fibrosis

87
Q

Bronchiolitis?

A

inflammatory obstruction of small airways

88
Q

BOOP: alveoli becomes filled with _____ tissue

A

connective

89
Q

Manifestations of bronchiolitis

A

rapid ventilatory rate (1)
dry non-productive cough (2)

90
Q

what is pulmonary fibrosis?

A

excessive amount of fibrous/connective tissue at alveoli

91
Q

what is the cause of pulmonary fibrosis?

A

scar tissue left from previous disease (e.g., tb)

92
Q

result of pulmonary fibrosis?

A

decreased lung compliance and external respiration (O2 & CO2 exchange)

93
Q

Results from _____ injuries at different lung sites associated with _____ healing

A

multiple; abnormal

94
Q

symptom of pulmonary fibrosis?

A

dyspnea on exertion

95
Q

Pulmonary edema?

A

excessive water on lungs

96
Q

cause of pulmonary edema?

A

left side heart disease
- reduced left side heat cardiac output
- blood backed up from heart into lungs
- increased b.p in pulmonary capillaries
- fluid forced into interstitial space between capillary and alveoli
- when fluid flow exceeds lymph system capability to remove = pulmonary edema occurs

97
Q

Severe COVID-19 manifested as viral pneumonia-induced ________

A

Acute Respiratory Distress Syndrome (ARDS)

98
Q

management of COVID-19?

A

intubation

99
Q

Mortality pts had _____ viral loads, meaning…

____ effects of virus not main cause of death

Death caused by _____ runaway immune response

A

undetectable; cytotoxic; host’s

100
Q

OLD: signs and symptoms?

A

dyspnea and wheezzing

101
Q

Asthma?

A

chronic inflammatory disorder of bronchial mucosa.

102
Q

what happens to the body when person is experiencing asthma?

A

inflammation
- restriction of airways
- hyper-immune response to irritants

103
Q

what is early asthma attack

A

classic immune response

104
Q

result of early asthma attack

A

inflammation, increased capillary permeability, increased fluid

105
Q

what is late asthmatic attack

A

begins 4-8 hours after early attack.

latent release of inflammatory mediators from original site

106
Q

result of late asthma attack

A

increased damage of epithelial cells = scaring/ increased mucus forming plugs/ increased airway resistance.

107
Q

T or F: during asthma, if PaCO@ is greater than 70 mmHg = sign of impending death

A

true

108
Q

T or F: if bronchospasms not reversed by usual treatment – it is considered as status asthmaticus

A

true

109
Q

tx of asthma

A

mild: inhalers
persistent: inhaled corticosteroids

110
Q

Pathopyhsiology of asthma:
(1) inhaled ____ passes epithelial layer

(2) antigen binds to ____ cells = release _____

(3) mediators = ___ production in airway/ ___ spasm/ ___ from increased capillary permeability

(4) ____ cells present antigen to ___ T cells = activate ___ cells/ activated ____ cells release antibodies

(5) Helper T cells also activate ____ / ___ activated/ inflammation from both results in airway _____

A

(1) antigen
(2) mast; mediators
(3) mucus; broncho; edema
(4) dendritic; helper; B;B
(5) eosinophil; neutrophil; obstruction

111
Q

COPD?

A

composed of chronic bronchitis & emphysema

112
Q

T or F: COPD is the most common chronic lung disease in the world

A

true

113
Q

T or F: COPD is the 1st leading cause of death worldwide.

A

False – fourth

114
Q

what is COPD characterize?

A

persistent airflow limitation, chronic inflammatory response to noxious particles or gas, progressive

115
Q

Chronic bronchitis?

A

hypersecretion of mucus/ chronic productive cough for at least 3 months of year of 2 consecutive years

116
Q

cause of chronic bronchitis?

A

inspired irritants (1) = inflammation/thickening of mucous membrane

reduced radius airways (2) = obstruction

117
Q

in Chronic bronchitis, airways collapse ___ in exhalation = air trapped in distal portions of lung = ___ = hypoventilation

A

early; hyperinflation

118
Q

Emphysema?

A

permanent enlargement of gas-exchange airways/ destruction of alveolar walls

119
Q

the obstruction of emphysema is due to destroyed walls of ____

A

alveoli

120
Q

result of emphysema?

A

reduced O2 and CO2 diffusion, expiration becomes difficult bec of loss of recoil of normal alveoli

121
Q

symptom difference between CB and Emphy:

A

CB = frequent cough with mucus

Emphy = shortness of breath

122
Q

large alveolar spaces = greatly ____ diffusion distance between alveoli and capillary

A

increases

123
Q

What is the result of large alveolar spaces with people with emphysema?

A

-reduced O2 and CO2 diffusion
- expiration becomes difficult bec of loss of recoil of normal alveoli

124
Q

What is the symptom difference between chronic bronchitis and emphysema?

A

Chronic bronchitis
- frequent cough with mucus

Emphysema
- shortness of breath

125
Q

What is acute bronchitis?

A
  • acute infection
  • inflammation of airways
126
Q

T or F: Acute bronchitis is usually self-limiting.

A

True

127
Q

T or F: Pneumonia mostly occurs due to viral infection.

A

FALSE; acute bronchitis

128
Q

What are the symptoms of acute bronchitis?

A
  • similar to pneumonia
  • non-productive cough aggravated by cold, dry air and dusty air
129
Q

What are the tx for acute bronchitis?

A

rest, aspirin, cough suppressant and antibiotics

130
Q

Which medication is commonly used for relieving pain, lowering fever and reducing inflammation?

A

aspirin

131
Q

What is the most common pathogen for pneumonia?

A

Streptococcus pneumoniae

132
Q

What are the common infections route for Streptococcus pneumoniae?

A

inhalation of infected individual’s cough

133
Q

What respiratory tract infections is associated with infection of lower respiratory tract caused by microorganisms (e.g., bacteria, viruses, fungi, protozoa & parasites)?

A

pneumonia

134
Q

What are the 2 categories of pneumonia?

A

HAP = hospital acquired pneumonia

CAP= community acquired pneumonia

135
Q

T or F: CAP is the second most common health-care associated infection.

A

FALSE; HAP

136
Q

The most common health care associated infection is _____ tract infection.

A

urinary

137
Q

For pneumonia, the hospitals suctioning tubes can become colonized with bacterial ____ which results to suction in seeding lung with bacteria. The guardian cells of lower respiratory tract are cellular ______ ______. Then the macrophages present antigens to Adaptive immune system which will activate _ & _ cells. The immune response can fill alveoli with debris, which then the microorganisms release ___ causing further damage.

A

biofilms; alveolar macrophages; B, T; toxins

138
Q

What causes the infection for tuberculosis?

A

Mycobacterium tuberculosis

139
Q

T or F: Acute bronchitis is the leading cause of death from a curable infectious disease in world.

A

FALSE; TB

140
Q

What respiratory tract infection is transmitted person-to-person via airborne droplets?

A

TB

141
Q

TB:
1. Pathogen reach ____, then engulfed by ____. They survive and ____ in macrophage.
2. Reproduction in macrophage causes ___ responses = more macrophages respond = ____ forms.
3. Macrophage start to ___, releasing pathogens and forms a center in tubercle – ____ stage.
4. Tubercle center enlarges (_______). The enlargement fills with air, thus ____ pathogen start to multiple outside macrophage.
5. Liquification continues, the tubercle rupture then the pathogens _____ throughout lung

A
  1. lung, macrophages, multiplies
  2. chemotactic, tubercle
  3. die, dormant
  4. liquification, aerobic
  5. disseminate
142
Q

What does pulmonary vascular diseases causes?

A

dramatic alterations in perfusion/ ventilation ratios

143
Q

Pulmonary blood flow disrupted causing ______ which leads to destruction of vascular bed

A

occlusion

144
Q

What is occlusion?

A

blocking or closing of blood vessel

145
Q

What is pulmonary embolism?

A

occlusion of portion of pulmonary vascular bed by embolus.

146
Q

The effecto pulmonary embolism depends on:

A
  • extent of pulmonary blood flow obstruction
  • size of affect vessel
  • ## nature of embolus
147
Q

Pulmonary artery hypertension is the mean pulmonary artery pressure greater than 25 mmHg at rest.

A

pulmonary artery hypertension

148
Q

What is the normal pulmonary artery pressure?

A

20 mmHg or less

149
Q

Pulmonary artery hypertension is associated with _____ dysfunction, which overproduced ______. This increased growth factors, leads to _______ (thickening of vessel walls). Thus there is the narrowing of vessels = gas exchange reduced. Then there is an increased in pulmonary artery pressure = increased pressure in _____ ventricle. Leads

A

endothelial; vasoconstrictions; fibrosis; right

150
Q

T or F: Cor pulmonale is associated with right ventricle hyperthropy

A

True

151
Q

What pulmonary vascular disease is associated with right ventricle enlargement due to hypertrophy or dilation or both?

A

Cor pulmonale

152
Q

What is Cor pulmonale the result of?

A

pulmonary artery hypertension

153
Q

What is the pathogen linked to laryngeal cancer?

A

HPV - human papillomavirus

154
Q

What are the primary risk factor for laryngeal cancer?

A

smoking - risk increases when smoking combined with alcohol consumption

155
Q

What are some manifestations for laryngeal cancer?

A

hoarseness, dyspnea, cough; cough following swallowing

156
Q

What are the diagnosis/tx for laryngeal cancer?

A

diagnosis - biopsy
tx - chemo & radiation

157
Q

Laryngeal cancer: The carcinoma of ___ ___ is the most common site. Metastasis occurs in ___ ___, but distant metastasis is rare.

A

vocal cord; lymph nodes

158
Q

What is the leading cause of death in Canadians?

A

lung cancer

159
Q

What malignancies of respiratory tract is associated with the tumors on respiratory tract epithelium?

A

lung cancer

160
Q

What is the most common cause of lung cancer?

A

smoking, gas exposure, second-hand smoke exposure

161
Q

What is responsible for causing 90% of lung cancers?

A

tobacco

162
Q

Tobacco smoke contains ___ carcinogens

A

30

163
Q

What is the progression for lung cancer?

A

metastasis to brain, bone marrow and liver

164
Q

How does tobacco affect bronchial mucosa?

A

suffers ‘hits’ from tobacco smoke = epithelial damage

165
Q

For lung cancer, the tumour is the result of growth factors and production of ____ ____.

A

free radicals

Pathophysiology (20 decks)

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