Final Exam- Pulmonary Flashcards
What are the 2 forms of O2 in serum
dissolved O2
hemoglobin bound O2
What are some factors that impact oxygenation
poor inspiration
alveolar damage
surfactant production
anemia
diseased tissue
What is the function of surfactant
prevents alveolar collapse
keep fluid and pathogens away
Term for inhalation of air into lungs and exhalation of air out of lungs
ventilation
What causes air to move in and out of lungs
change in intrathoracic pressure
based on contracting of diaphragm and intercostal muscles
What happens to diaphragm on inspiration
moves down (contracts)
What happens to diaphragm on expiration
moves up (relaxes)
what occurs during hyperventilation
ventilation exceeds the metabolic demand
hypocapnia (blow out excessive CO2=respiratory alkalosis)
What occurs during hypoventilation
inadequate ventilation related to metabolic demand
hypercapnia= slower breathing/high CO2
What is the effect of severe hypercapnia
vasodilation
increased intracranial pressure= decreased cerebral diffusion
mental status changes
What is the effect of severe hypocapnia
vasoconstriction
decreased cerebral perfusion= mental status changes
What are the main muscles used for normal inspiration
diaphragm
external intercostal muscles
What accessory muscles are used if a person is struggling to breathe
I: sternocleidomastoid; scalene
E: abdominal; internal intercostal
2 major causes of obstructed ventilation
compressed; narrowing of airway
disrupted neural transmission to stimulate air movement
Measure of ease of expansion of lungs
lung compliance
What impacts ease of lung expansion
lung elasticity
elastic recoil of chest wall
What can changes in lung compliance/ airway resistance affect
oxygenation and ventilation
any impediment to airflow on inspiration or expiration
airway resistance
What impacts airway resistance
change in airway diameter
airway obstruction
blood flow to lung tissue
perfusion
What impacts perfusion
cardiac function
shock
narrowed blood vessels
blood vessel obstruction
Term when blood leaves heart without doing gas exchange
shunting
Anatomical vs intrapulmonary shunt
ventricular septal defects
vs
blood enter pulmonary space w/o doing gas exchange
Term for area of lung where there’s no perfusion
dead space
What leads to dead space
blood supply obstruction
shunting
What are the 2 types of respiratory failure
hypercapnic
hypoxemic
CO2 and pH in Hypercapnic respiratory failure
high CO2
low pH (not compensated)
Mechanisms of hypercapnic respiratory failure
respiratory disorder that affects ventilates
CNS disorder (brainstem injury)
chest well disorder (muscle damage)
neuromuscular disorder (myasthenia gravis)
What is seen with hypoxemic respiratory failure
shunting
diffusion limitation
alveolar hypoventilation
VQ mismatch
Condition where part of the chest wall is unstable from a trauma/CPR
flail chest
Manifestations of Flail chest
SOB (hypoxia/hypercapnia)
inward movement on inspiration
outward movement on expiration
Term for collapsed lung
pneumothorax
Primary vs Secondary pneumothorax
from a bleb rupture (in healthy ppl)
vs
chest trauma, CPR, mechanical ventilation, iatrogenic
What is the mechanism of an open pneumothorax
air fils in pleura on inspiration and leaves on expiration
drops negative pressure
lung collapses
What is the mechanism of a tension pneumothorax
air goes in pleural space after an injury but doesn’t leave
shifts the heart/trachea
Manifestations of pneumothorax
tachypnea
chest pain (sharp when breathing)
decreased breath sounds on affected side
Term for excess fluid in pleural space
pleural effusion
What diagnostic test is used for pleural effusion
diagnostic thoracentisis- to determine infection
Term for watery fluid in pleural effusion
transudative
Term for WBCs and plasma protein fluid in pleural effusion
exudative
Term for passage of fluid, food, or gastric fluids into lungs
aspiration
Term form collapse of alveoli
atelectasis
When does atelectasis occur
after surgery
immobile patients
patients with pneumonia
Term for persistent dilation of bronchi
bronchiectasis
What are causes or bronchiectasis
excess mucus, aspiration, CF
How does bronchiectasis occur
accumulation of mucus wides the airway
impacts gas exchange
Term for inflammatory obstruction of bronchioles
bronchiolitis
Causes of bronchiolitis
respiratory infection (RSV)
inhaled toxic gas
repeated infections
Manifestations of bronchiolitis
hyper inflated chest
respiratory distress
What is the mechanism of pulmonary fibrosis
chronic inflammation leads to changes in lung tissue
less compliance in lungs leading to ventilation issues
Manifestation of pulmonary fibrosis
coarse crackles
Term for excess water in lungs
pulmonary edema
What is a predisposing factor to pulmonary edema
left sided heart failure due to increased capillary hydrostatic pressure
Manifestations of pulmonary edema
crackles
pink frothy sputum
Condition where there is damage to lungs from pneumonia, smoke inhalation, trauma that triggers an inflammatory response
acute lung injury
What are the criteria to get diagnosed with acute lung injury
bilateral infiltrate on chest radiography
low O2
not from heart failure
What determines an ARDS diagnose
acute lung inflammation + diffuse alveolocapillary injury
What are the 3 phases of acute lung inflammation/ARDS
exudative phase (72 hrs)
proliferative phase (4-21 days)
fibrotic phase (14-21 days)
Manifestations of acute lung inflammation/ARDS
leukocytosis
rales, rhonchi, wheezing
white out on X-ray
Chronic airway disorder from constricted airways that affect ventilation
asthma
Manifestations of an asthma attack
expiratory wheeze
exercise intolerance
diminished breath sounds
Status asthmaticus
severe bronchospams that don’t react to treatment –> leads to hypoxemia/hypercapnia –> eventually intubated
Diagnostic criteria for chronic bronchitis
hyper secreted mucus
chronic but productive cough that lasts 3 months
What is the mechanism of chronic bronchitis
inflammation leads to airway edema
this increased goblet cells
fibrosis of smooth muscle impaired ciliary
airways narrow
Manifestations of chronic bronchitis
blue bloater (cyanotic color)
polycythemia (elevated RBS w/o enough O2)
Hi pCO2
cor pulmonale
Term for abnormal permanent enlargement of gas-exchange airways
emphysema
What are the pathological effects of emphysema on the body
alveoli are enlarged/destroyed
loss of elastic recoil
Manifestations of emphysema
pursed lip breathing
pink puffer (skin)
alveolar changes seen on X-ray
polycythemia
cor pulmonale
What diseases are included in COPD
chronic bronchitis
emphysema
asthma
Manifestations of COPD
barrel chest
clubbing of nails
chronic SOB
What are risk factors for obstructive sleep apnea
excessive weight (on neck)
narrowed airways
Manifestations of obstructive sleep apnea
apneic pauses while sleeping
snoring
daytime sleepiness
chronic mouth breathing
Term for infection of lower respiratory tract
pneumonia
Risk factors for pneumonia
immunosuppression, lung disease, smoking, intubation
Sources of pneumonia infection
inhaled from someone’s cough/sneeze
inhaled aerosolized contaminated water
bacteremia
Pneumonia manifestations
fever
pleural pain
hemopytsis (coughed up blood)
rales/rhonchi lung sounds
How is pneumonia diagnosed
xray, sputum culture, urine antigen test for legionella
Tuberculosis is pneumonia caused by a ________________
bacteria
What is often formed with TB/ what happens
lesions (tubercle)
tissue necrosis leads to scar tissue around the tubercle
Manifestations of tuberculosis
weight loss
night sweats
hemoptysis
Diagnostic testing for tuberculosis
AFB culture, xray to check for cavities in lungs
Term for localized destruction of lung tissue
lung abscess
What causes a lung abscess
aspiration
Manifestations of lung abscess
fever
foul-smelling sputum
hemoptysis
Diagnostic test for lung abscess
CT to see walled of area of pus in lungs
Term for full/partial occlusion of pulmonary vessel by a clot
pulmonary embolism
Pulmonary embolisms commonly start as ___________________
DVT in leg that migrates
Risk factors for pulmonary embolism
limited mobility
oral contraceptives
Manifestations of pulmonary embolism
acute SOB
chest pain
R. heart enlargement on ultrasound
Diagnostic test for pulmonary embolism
CT w/ contrast
ultrasound
check D dimer levels
What number designates pulmonary artery hypertension
mean arterial pressure that is greater than 25 at rest
