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Pathophysiology > Final: Ch 23 Disorders of Ventilation & Gas Exchange > Flashcards

Final: Ch 23 Disorders of Ventilation & Gas Exchange Flashcards

1
Q

what is ventilation

A

movement of air into the lungs

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2
Q

what is perfusion

A

circulation of blood through pulmonary vessels

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3
Q

what is diffusion

A

oxygen and CO2 x respiratory membrane

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4
Q

what is hypoxemia

A

low arterial PO2

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5
Q

symptoms of hypoxemia

A

mental confusion, restlessness, agitation, combativeness

cyanosis when deoxygenated Hb > 5g/dl

SNS activation

PA vasoconstriction and polycythemia when chronic

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6
Q

diagnosis and treatment of hypoxemia

A

diagnosis: ABG, pulse oximeter
treatment: correct the cause – give O2 and/or ventilate

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7
Q

hypercapnea, symptoms, treatment

A

High CO2 in blood

hypoventilation or severe V/Q mismatch

symptoms: acidosis
treatment: mechanical support to improve ventilation

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8
Q

how to distinguish between cardiac and respiratory pain?

A

taking a deep breath doesn’t increase cardiac pain, but does increase respiratory pain

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9
Q

types of pleura

A

visceral pleura: covers lung

parietal pleura: lines chest cavity

pleural space inbetween - fluid

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10
Q

is there normally negative pressure in the lung system?

A

yes

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11
Q

pleuritis

A

inflammation of the pleura (localized) - acute pain

worse with deep breathing/coughing

may need analgesics, NSAIDS

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12
Q

pleural effusion

A

abnormal collection of fluid in the pleural cavity

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13
Q

causes of pleural effusion

A

negative intrapleural pressure (atelectasis)

high capillary pressure (HF)

high capillary permeability (infection)

low lymph drainage (mediastinal cancer)

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14
Q

symptoms of pleural effusion, diagnosis, treatment

A

symptoms: dyspnea, low breath sounds, hypoxia

Dx: chest x-ray, CT scan

treatment: thoracentesis

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15
Q

what is transudate

A

serous fluid - HF

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16
Q

what is exudate

A

fluid with protein or LDH

inflammatory process

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17
Q

what is empyema

A

pus in the pleural cavity

rupture of an abscess

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18
Q

what is chylothorax

A

lymph in the pleural cavity

trauma, inflammation, malignancy

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19
Q

what is hemothorax

A

blood in the pleural cavity

trauma, aneurysm, malignancy

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20
Q

pneumothorax

A

air in the pleural cavity causing partial or complete lung collapse

spontaneous or traumatic

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21
Q

spontaneous pneumothorax is caused by what, and types (primary/secondary)

A

caused by the rupture of a bleb

primary: no known cause (common in tall men + smokers)
secondary: asthma, TB, CF, lung cancer

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22
Q

spontaneous pneumothorax leak

A

lung collapse can seal the leak

otherwise, the leak continues until a negative intrapleural pressure is abolished

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23
Q

traumatic pneumothorax

A

caused by a rib fracture or penetrating external wound

may be accompanied by other traumatic injuries like a hemothorax

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24
Q

tension pneumothorax (life-threatening)

A

opening from pleural space covered by flap valve

air enters during inspiration but can’t leave

pleural pressure > atmospheric

mediastinum shifty and other lung and great vessels compromised

type of traumatic pneumothorax

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25
Q

symptoms of pneumothorax

A

depends on size

respiratory distress and hypoxemia

asymmetry of the chest

tension pneumo can cause cardiovascular collapse

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26
Q

diagnosis of pneumothorax

A

chest x-ray

CT

ABG

pulse oximetry

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27
Q

treatment of pneumothorax

A

a small spontaneous one may resolve itself

needle aspiration or chest tube and closed drainage

tension pneumo - emergency chest tube

cover sucking chest wounds with an airtight dressing

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28
Q

on a CXR what does a collapsed lung look like

A

an empty, dark space

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29
Q

what is atelectasis and what are the types

A

incomplete expansion of part of the lung

caused by a blockage of airway, compression, or lack of surfactant

primary or acquired

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30
Q

primary atelectasis

A

infant’s lung fails to expand at birth

seen in premature and high risk infants

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31
Q

acquired atelectasis

A

caused by bronchial obstruction or external compression (tumor, pleural effusion, mucus plug)

once bronchus becomes obstructed, air is absorbed from alveoli leading to the atelectasis

seen post op: pain, anesthesia, immobilization –> retention of secretions

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32
Q

symptoms of atelectasis

A

tachypnea

tachycardia

dyspnea

cyanosis

low breath sounds

fever

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33
Q

diagnosis and treatment of atelectasis

A

Dx: CXR, CT

Rx: mobilization and cough/deep breath for post op patients (produces neg pressure)

may require bronchoscopy

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34
Q

what is obstructive airway disease

A

caused by an obstruction that limits expiration

reversible (asthma), or not (COPD)

bronchial smooth muscle plays a role

SNS dilates and PNS constricts bronchi

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35
Q

bronchial asthma

A

bronchospasm and activation of inflammatory cells

always hyper-responsive

wheezing, cough, SOB

36
Q

asthma acute phase (10-20 min) response

A

immediate bronchoconstriction (SMC activation) to antigen or irritant

sensitized mast cells release histamine

mucus membranes are permeable to cells/antigen

increased vascular permeability causes mucosal edema

37
Q

what reverses the acute phase of asthma

A

beta2-agonists

dilators

38
Q

asthma late phase (4-8hrs) response

A

sensitized mast cells release histamine

strong inflammatory response

multiple types of leukocytes recruited

cholinergic nerves activated

39
Q

are early childhood infections preventative of asthma?

A

can be

40
Q

extrinsic causes of asthma

A

airborne allergens

familial pattern

41
Q

intrinsic causes of asthma

A

respiratory infection

inhaled irritants

NSAIDS, beta-blockers

emotional trigger

GE reflux

exercise

42
Q

VE

A

minute ventilation

VE = Vt x RR

43
Q

FRC

A

fractional residual capacity

44
Q

FVC

A

forced vital capacity

45
Q

Vt - Vd

A

dead space

46
Q

VE =

A

VT x f (500ml/breath x 12 breaths/min) = 6L/min

47
Q

symptoms of asthma

A

wheezing, chest tightness

prolonged expiration, air trapping (high RV, low FVC)

alveolar ventilation less effective –> V/Q mismatch (shunt) –> hypoxia

48
Q

symptoms of mild asthma attacks

A

chest tightness

wheezing

cough

49
Q

symptoms of severe asthma attacks

A

distant breath sounds

loud wheezing

inaudible breath sounds and wheezing signals onset of respiratory failure

50
Q

FEV1

A

forced expiratory volume in 1 second

how much was breathed out in 1 second?

51
Q

diagnosis of asthma

A

H&P

spirometry FEV1/FVC low, PEF low

peak expiratory flow (PEF) meter

methacholine challenge to trigger attack

see if bronchodilators reverse

52
Q

treatment of asthma

A

education and desensitization to allergens

53
Q

short-term meds for asthma

A

beta-agonists (albuterol, terbutaline) by inhaler

anti-cholinergics by inhaler

systemic steroids

54
Q

long-term meds for asthma

A

steroids

mast cell stabilizers

long-acting beta-agonists

SMC relaxers

leukotriene modifiers (block synthesis/receptors)

Xolair: monoclonal Ab against IgE

55
Q

how is asthma classified

A

by severity

allows proper treatment and identification at those at risk for complications

56
Q

severe asthma

A

virtually constant symptoms and requires frequent use of steroids

deterioration can be rapid - don’t delay treatment

57
Q

chronic obstructive pulmonary disease: COPD

A

a group of diseases that produce chronic obstruction of air flow

4th leading cause of death in US

58
Q

what causes COPD

A

smoking

alpha1-antitrypsin deficiency

59
Q

when do you get symptoms of COPD?

A

when the disease is advanced

60
Q

in COPD, the airway can be obstructed by… 3 things

A

fibrosis with hypertrophy of bronchial wall

inflammation with hyper-secretion of mucus

destruction of elastic fibers

61
Q

progression of COPD

A

destruction of alveoli decreases gas exchange area

destruction of elastic fibers causes airway collapse

V/Q mismatch = wasted effort and hypoxia

low elastic recoil causes airway collapse and air trapping

62
Q

2 types of COPD

A

emphysema - enlarged airspaces

chronic bronchitis - small airway obstructions

63
Q

emphysema

A

loss of lung tissue (elastic, alveolar walls destroyed)

airspaces enlarged

lungs hyperinflated

high TLC

64
Q

_______ is the leading cause of emphysema

A

smoking

65
Q

smoking and emphysema

A

activates macrophages and neutrophils to release elastases

decreases antitrypsin activity (inhibits elastases)

elastin fibers destroyed

66
Q

genetics of alpha1 antitrypsin deficiency

A

PI (protein inhibitor) genes produce alpha1 antitrypsin

PIZ mutation most severe 5% of population

homozygotes have 1/5 or less of normal enzyme activity

67
Q

if emphysema in a person less than 40 YOA then cause is likely…

A

alpha1 antitrypsin deficiency

68
Q

2 types of emphysema

A

centriacinar

paracinar

69
Q

centriacinar emphysema

A

bronchioles in central lung affected 1st

alveoli initially normal

common in male smokers

70
Q

paracinar emphysema

A

peripheral alveoli affected 1st

bronchioles initially normal

common in alpha1-antitrypsin deficiency

71
Q

chronic bronchitis cause

A

caused by inflammation of airways (hyperplasia and a lot of mucus production)

middle aged males that smoke (multiple infections)

bacterial/viral infection

72
Q

diagnosis of chronic bronchitis

A

cough for 3 months consecutively fo 2 years

73
Q

progression of COPD

A

from cough to severe respiratory distress

74
Q

older terminology for COPD

A

pink puffer: emphysema

blue bloater: chronic bronchitis

most people with COPD have some of both

75
Q

emphysema causes loss of both _________ & _________

A

ventilation & perfusion

76
Q

emphysema causes hypoxia when

A

late in disease

77
Q

chronic bronchitis leads to _______ obstruction, and low V/Q areas lead to _______

A

airway, hypoxia

78
Q

symptoms of emphysema

A

dyspnea with use of accessory muscles

seated position at night

barrel chest from air trapping

pursed lip breathing

79
Q

symptoms of chronic bronchitis

A

dyspnea

exercise intolerance

hypoxia & hypercapnea

polycythemia –> HTN + Rt HF

80
Q

death from COPD occurs from

A

exacerbation from infection

eventually respiratory failure

81
Q

diagnosis of COPD

A

CXR - shower hyperinflation

PFT’s: FEV1 and FEV1/FVC are low

TLC & RV high

if FEV1/FVC less than 50% – severe disease

exercise tolerance test

blood gases

82
Q

CXR of a COPD patient

A

hyperinflation seen as:

increased lung volume

low flat diaphragm

increased retrosternal air

83
Q

treatment of COPD

A

stop smoking

prevent respiratory infection

increase physical/psychosocial function

O2 therapy when hypoxia present (PO2 to 60)

84
Q

drugs for COPD

A

beta-agonists

anti-cholinergics

theophylline

steroids

85
Q

bronchiectasis

A

uncommon, but serious type of COPD (airway obstruction)

2ndary to persistent infection/inflammation (TB)

86
Q

symptoms of bronchiectasis

A

productive cough

purulent sputum

hemoptasis

anemia

weight loss

87
Q

diagnosis/treatment of bronchiectasis

A

H&P, CXT, CT

postural drainage, chest PT, treat infection

Pathophysiology (24 decks)

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