Pulmonary Pathophysiology (1) Flashcards
1
Q
____ refers to the movement of air in and out of the lungs
A
Ventilation
2
Q
Ventilation is responsible for the removal of ___ from the body
A
CO2
3
Q
_____ refers to the delivery of oxygen to the alveoli and the diffusion of O2 into the pulmonary capillaries
A
Oxygenation
4
Q
The processes of ventilation and oxygenation are ___
A
Linked
5
Q
The central nervous system regulates ____, ____, and ____ of breathing
A
Rate, depth, and rhythm
6
Q
____ ___ have the strongest influence on regulation of ventilation
A
Central chemoreceptors
7
Q
A decrease in the pH of ____ ____ increases ventilation
A
Cerebrospinal fluid
8
Q
____ ____ also affect ventilation
A
Peripheral chemoreceptors
9
Q
What are some examples of peripheral chemoreceptors?
A
-Aorta (PaO2 and PaCO2)
-Carotid bodies
10
Q
Carotid bodies can impact ventilation due to changes in…
A
-PaO2 and PaCO2
-Decreased pH
-Increased temperature
-Low perfusion
-Nicotine, cyanide, carbon monoxide
11
Q
What two types of receptors also impact ventilation?
A
-Stretch receptors
-Baroreceptors
12
Q
What are two baroreceptors?
A
-Carotid sinus
-Aortic arch
13
Q
Carotid sinus baroreceptors are responsive to both increases and decreases in arterial pressure, while aortic arch baroreceptors are only responsive to ____
A
Increases
14
Q
Stretch receptors and baroreceptors limit how much ___ you can take in and the stretch of the lungs
A
Oxygen
15
Q
What are the muscles of ventilation:
A
-Diaphragm
-Intercostals (internal/external)
-Accessory muscles
16
Q
What nerve controls your diaphragm?
A
Phrenic nerve (innervated by C3, C4, C5)
17
Q
If a spinal cord injury is above the C3, C4, and C5, the patient might not have ____ ____
A
Diaphragmic breathing
18
Q
What are three accessory muscles:
A
-Scalene
-Trapezius
-Sternocleimastoid
19
Q
What makes up the upper respiratory tract?
A
-Nasal cavity
-Sinuses
-Naso, Oro, laryngopharynx
-Larynx
20
Q
What makes up the lower respiratory tract?
A
-Airways
-Alveoli
-Lymphatics
21
Q
If you bypass the upper airway, you bypass ____ and over time, the secretion in the lower lungs get too thick and you can’t cough them up
A
Humidification
22
Q
Conduction airways generate from branches __-__
A
1-16
23
Q
Respiratory airways generate from branches ___-___
A
17-23
24
Q
Branch ___-___ is where gas exchange occurs
A
20-23
25
____ cells produce mucus (Emphysema and other conditions effect these cells and cause mucous to become too thick)
Goblet
26
____ cells replace damaged epithelial cells in the airway
Progenitor
27
Type 1 alveolar cells are ___ ___
Basal alveoli
28
Type 2 alveolar cells secrete ___
Surfactant
29
Alveoli must always be open to allow for ___ ___
Gas exchange
30
A liquid called ____ keeps alveoli open
Surfactant
31
If there is damage to the alveolar border, ____ and ____ can get into the alveoli which prevents oxygen from getting in; this causes alveolar collapse and damage to type 2 cells
Protein and fluid
32
When activated/in overdrive, ___ ___ initiate macrophage and cytokine response which damages alveoli
Alveolar macrophages
33
When activated/in overdrive, ___ ___ initiate macrophage and cytokine response which damages alveoli
Alveolar macrophages
34
Breathing is a ____ function
Mechanical
35
Breathing causes changes in ____, ____ and ____
Pressure, volume, flow
36
What things allow for changes in volume?
-Diaphragm
-Muscles (intercostal and accessory)
37
With inspiration, the diaphragm _____ downward to allow room for increased air volume of the lungs
Contracts
38
With inspiration, the thoracic cavity ___
Expands
39
With inspiration, the external intercostal muscles ___
Contract
40
With expiration, the thoracic cavity ____
Reduces
41
With expiration, external intercostal muscles ____
Relax
42
The diaphragm ____ during expiration
Relaxes
43
What might impact flow of air into the lungs?
-Diameter of the airway
-Compliance of the lung
-Compliance of the chest wall
-Elastance
44
Those with ____ have low compliance of the chest wall
Burns
45
Changes in pressure of the lungs are due to ___ ___
Muscle contraction
46
When the chest wall expands, it brings the ___ with it so that air can fill
Lungs
47
With a long and/or narrow breathing tube, there would be ___ resistance
High
48
With a small and/or wide tracheotomy tube, there would be ____ resistance
Low
49
Transpulmonary pressure is ___ mm Hg
4
50
Intrapleural pressure is ___ mm Hg
-4
51
Pneumothorax is when air gets into the ___ ___ of the lungs
Pleural space
52
Normally, we do not get rid of ___ ___ of oxygen in the lungs, meaning there will always be some oxygen in the lungs
Residual volume
53
Tidal volume is equal to...
Dead space + alveolar ventilation
54
___ of tidal volume does not participate in gas exchange and is considered anatomic deadspace ventilation
1/3
55
(Deadspace ventilation)/(tidal volume)=
(PaCO2 - PECO2)/PaCO2
56
Dead space is normal, but we don't want dead space in the ____ because that would be there is no gas exchange through the lungs
Alveoli
57
Volume and speed of air flow can be measured using ____
Spirometry
58
What can spirometry measure:
-Forced vital capacity (FVC)
-Forced expiratory volume (FEV1)
-FEV1/FVC
-Peak expiratory flow rate (PEF)
59
We can also measure someone's response to ____ or ____ to look at lung function
Bronchodilators; exercise
60
We are able to determine lung size by measuring volume with what two tests?
-Total lung capacity
-Residual volume
61
We can measure gas exchange with what test?
Diffusing capacity for carbon monoxide (DLCO)
62
If someone has reversible airway disease, they would have a ____ forced vital capacity on bronchodilators
Increased
63
Technique of spirometry:
-Obtain height, age, gender
-Patient blows into a device that records volume and the speed gas leaves the lungs
64
What three things does spirometry calculate?
-Predicted: norm based on height, age, and gender
-Best: highest flow
-% predicted: % of normal
65
Percent predicted should be at least ____%
80
66
The ___-___ ___ is a plot of inspiratory and expiratory flow against volume during the performance of maximally forces inspiratory and expiratory maneuvers
Flow-Volume Loop
67
Someone with a forces vital capacity 65% of predicted, a forced expiratory volume 37% of predicted, and a FEV1/FVC 46% of predicted would have ____ lung disease
Obstructive
68
The goals of spirometry include:
-Diagnose type of dysfunction
-Determine extent of dysfunction
-Monitor change over time (normal 20 mL/year or greater)
-Monitor response to treatment
-Preop, disability assessment
69
Bronchodilators improve ____
Volume
70
Obstructive lung diseases can affect the ___ or ___ airway
Upper or lower
71
What are three obstructive upper airway lung diseases?
-Croup/Epiglottitis
-SUID
-Sleep apnea
72
What are three lower airway obstructive lung diseases?
-Cystic fibrosis
-Asthma
-COPD
73
What are 4 categories of restrictive lung diseases:
-Lung tissue
-Dust diseases
-Nerves/muscles
-Chest wall
74
What are three lung tissue restrictive diseases?
-Idiopathic
-Pulmonary fibrosis
-Covid (long haul)
75
What three things can cause dust-related restrictive lung diseases?
-Silica
-Asbestos
-Coal
76
What things can cause nerve/muscle related restructed lung disease?
-ALS
-Post-Polio
-High cord injury
77
What types of chest wall deformities can cause restrictive lung disease?
-Kyphoscoliosis
-Flail chest (fractured ribs)
78
What are examples of vascular lung diseases?
-ARDS
-Pulmonary emboli
-Pulmonary hypertension
79
Obstructive lung diseases affect ____ of air
Flow
80
Restrictive lung diseases affect ____ of inspired air
Volume
81
Vascular lung diseases affect ___ and ___
Fluid and flow
82
What can cause airway obstruction?
-Narrowing of airways
-Object obstructing flow
-Loss of lung tissue
83
What can cause narrowing of airways?
-Airway inflammation
-Smooth muscle contraction
84
What objects might obstruct flow?
-Sputum
-Tumor
-Foreign body
85
What might cause a loss of lung tissue?
Emphysema
86
With emphysema, tissue is destroyed which causes a ___ airway that closes early during expiration
Small
87
Emphysema leads to ___ ___
Air trapping
88
With emphysema, there is ____ elastic recoil and ____ closing volume
Decreased; increased
89
Emphysema causes lungs to be ____, so they can't get the air out on exhale which makes it hard to get the next breath in
Overcomlpliant
90
What may be done for treatment of emphysema?
-Lung reduction surgery
-Valves to help deflate lungs on exhale
91
Obstructive lung diseases cause a change in the inspiratory:expiratory ratio from ____ to ____
1:2 (normal) to 1:3-4 (this means that it takes a lot longer for people to exhale)
92
For those with obstructive lung diseases, it helps to create ____ to the inhale by inhaling through pursed lips to create back pressure to open the airways to the exhale
Resistance
93
Someone with an obstructive lung disease would have _____ intercostal spaces and a ___, ___ diaphragm
Wide; low and flat
94
On a chest X-ray of someone with obstructive lung disease, you would see a lot of ___ space which indicates excess oxygen since they are chronically in an air-trapping system
Black
95
What are some signs of respiratory distress in someone with obstructive lung disease?
-Frequent coughing or wheezing
-Excess phlegm or sputum
-Shortness of breath
-Trouble taking a deep breath
-Exacerbation
-Hypoxemia
-Pedal edema
-COPD
96
Pulmonary vasoconstriction might lead to ___ ___ ___
Right ventricular failure
97
___ ___ is dilation of the right ventricle caused by attempts to pump against increased peripheral vascular resistance
Cor pulmonale
98
Right ventricular failure may lead to distension of the ___ ___
Jugular vein
99
Right ventricular failure can also lead to ___ ___ since blood backs up to arms and legs
Peripheral edema
100
With obstructive lung diseases, ____ is used to monitor severity
FEV1
101
Classifications of severity for obstructive lung disease:
Mild: FEV1 > 70-79% predicated
Moderate: FEV1 60-69%
Moderately severe: FEV1 50-59% predicted
Severe: FEV1 35-49% predicted
Very severe: <35% predicted
102
All severities of obstructive lung disease have a FEV1/FVC less than ____%
70
103
With obstructive lung diseases, you can't get air ____, whereas with restrictive lung diseases, you can't get air ___
Out; in
104
What conditions can restrict lung function?
-High spinal cord injury (C3-C5)
-Amyotrophic lateral sclerosis
-Duchenne's Muscular Dystrophy
-Idiopathic pulmonary fibrosis
-Dust (silicosis, asbestosis, pneumoconiosis)
-Kyphoscoliosis
-Fractured ribs
105
What are three possible causes of a volume problem?
-Chest wall cannot move normally
-Muscles and nerves do not work
-Lung tissue is fibrous/dust filled
106
With restrictive diseases, there is ___ volume in and ____ volume out, but a normal speed of respiration
Less, less
107
What are three consequences of restrictive lung diseases?
-Tidal volume is decreased
-CO2 is not flushed from the lungs
-Acid-base balance is affected
108
Restrictive lung diseases cause ___ ___
Respiratory acidosis
109
Respiratory acidosis causes ___ PaCO2 and ____ pH
Increased; decreased
110
With restrictive lung disease, the airway is not ____, so simple measures may help increase tidal volume
Obstructed
111
What are some options to increase tidal volume?
-Mouth held support during the day
-Mask at night (avoids trach)
-Mechanical ventilation at night (no mouth held support during the day)
112
Mouth held support during the day supplements tidal volume to remove ___
CO2
113
Decreases in ____ estimates severity of restrictive lung diseases
FVC (forced vital capacity)
114
Classifications of severity for restrictive lung diseases:
-Mild: FVC <80-70%
-Moderate: FVC <70-55%
-Severe: FVC < 55%
115
Lower limit of normal for lung disease:
-5th percentile OR
- <80% predicted FEV1 and FVC OR
- <70% predicted FEV1/FVC
116
With an obstructive pattern, there is ___ air in and ____ rate of expiration
Less, slower
117
With a restrictive pattern, there is ___ air in and a ____ rate of expiration
Less, normal
118
If FEV1/FVC is less than lower limit nomal, it would be an ____ lung disease
Obstructive
119
If FVC is less than lower limit normal for an obstructive disease, it would be _____ or ___ ____
Obstructive or mixed volumes
120
If FVC is greater than the lower limit normal, this would indicate...
-Mild disease or asthma
121
If FEV1/FVC is greater than the lower normal limit and FVC is less than lower normal limit, this would indicate ____ lung disease
Restrictive
122
If FEV1/FVC is greater than the lower normal limit and FVC is greater than the lower normal limit, this would indicate...
Normal lung function
123
With inflammation of the upper airway structures, there is a risk of ___ ___
Airway obstruction
124
Why does inflammation of the upper airway cause a risk of airway obstruction?
-Inflammation narrows the airway
-Anatomy restricts ability to expand
-Trachea incomplete rings
-Cricoid cartilage complete ring
125
The risk of airway obstruction is more common in ___, since their airway is shorter and narrower
Children
126
What age group is at the highest risk for developing croup?
6 months-3 years
127
If there is a family history of croup, someone is ___ times more likely to develop croup
3.2
128
With croup, the virus infects the ___ ___
Nasal mucosa
129
The croup virus then spreads to the ___ and ___
Larynx and trachea
130
Croup causes ____ and narrows airways in the subglottic region (below the vocal cords)
Inflammation
131
The ___ ___ is rigid and cannot expand with croup
Cricoid cartilage
132
The hallmark of croup is "___ ___"
Steeple sign
133
With croup, we should evaluate the severity of what symptoms?
-Cough (occasional or frequent)
-Stridor/noisy breathing (none, at rest)
-Retractions (none, mild, marked)
-Agitation (none, at rest)
134
Therapy to manage mild croup:
-Fluids
-Humidity
-Antipyretics
135
Therapy to manage severe croup:
-Steriods
-Nebulized epinephrine
136
Who is at risk for epiglottitis:
-Immunocompromised
-Child not immunized (Haemophilus influenzae)
137
Pathogenesis of epiglottitis:
-Bacteria infection
-Rapidly progresses
-Cellulitis (edema, narrows airway)
-Life-threatening airway obstruction
138
What should you evaluate to determine the severity of epiglottitis?
-Visualize epiglottis in a safe setting
-Drooling/anxiety
-Signs and symptoms of infection
139
How is epiglottitis managed?
Antibiotics
140
What is an example of an obstructive disease secondary to altered breathing?
Sudden Infant Death Syndrome
141
___ ____ ___ ___ can either be explained or unexplained
Sudden Unexpected Infant Death
142
___ ___ ___ ___ is sudden and unexpected death in an infant less than 1-year-old with no obvious causes after autopsy and investigation
Sudden Infant Dead Syndrome
143
About ___% of SUID cases are SIDS
50
144
There is the highest risk of SIDS at ___-___ months of age
2-4
145
90% of SIDS cases occur before ___ ____ of age
6 months
146
2018 CDC data shows that there were 3400 causes of SUID, which ___ of those being explains and ____ being unexplained
1300; 2100
147
The 1,300 explained cases of SUID were due to...
Accidental suffocation (sheets, blankets)
148
Of the 2100 explained cases of SUID, ____ of them were caused by SIDS
1300
149
SIDS occurs in infants who...
1. Have underlying vulnerability
2. Experience a trigger event
3. Are at vulnerable developmental stage of the CNS
150
What are some examples of underlying vulnerability?
-Premature birth/low birthweight
-Deficiency in serotonin or alteration signaling
-Cardiac/genetic variants
-Arousal failure
151
A premature birth/low birthweight causes delayed maturation of regions in the brain that regulate ___ ___ to hypoxia (decreased PaO2) and hypercarbia (increased PaCO2)
Ventilatory response
152
A deficiency in serotonin or alteration signaling alters ____ in the medulla
Respirations
153
A deficiency in serotonin or alteration signaling is associated with ____ exposure in utero
Nicotine (maternal smoking/2nd hand smoke)
154
The trigger event common to all causes of SIDS is ___ ___, which means that the infant doesn't turn its face or lift its head to inhale, so they inhale CO2 and go into respiratory arrest
Arousal failure
155
____ position increases risk of arousal failure
Prone
156
Data on SIDS is not good because we can't conduct ___ ___ ___, so we do epidemiological research and infer from data
Randomized control trial
157
Infant risk factors for SIDS:
-Low birth weight, premature
-Sleep position (prone)
-Sleep environment (sleep surface (not firm), bed-sharing, overheating, swaddling)
158
What are some maternal risk factors for having a child with SIDS?
-Race (African American, American-Indian)
-Smoking (during pregnancy or 2nd hand smoke)
-Drug/alcohol abuse
159
What is the triple risk model of SIDS?
-Vulnerable infant (preterm, LBW, nicotine exposure)
-Critical period (2-4 months)
-Environment (sleep environment/position)
160
There is a large variation in rates of SUID between ___ and ____
States and countries
161
What factors might impact large variations in rates of SUID?
-Smoking rates
-Racial/cultural factors (increased in Native Americans)
-Bed sharing
162
Another example of an obstructive disease secondary to altered breathing is...
Sleep Disordered Breathing
163
What are the two distinct stages of sleep?
-NREM
-REM
164
____ predominates in the first 1/3 of the night, while ____ predominates in the last 1/3
NREM; REM
165
What happens in REM sleep?
-Breathing is irregular
-Apneas occur in normals
-Muscle activity is reduced
-Decreased depth of breathing (tidal volume)
166
Who is at risk of sleep-related breathing disorders?
-Those whose airway narrows during sleep
-Those who are obese
-Those with obstructive airways
-Obstructive sleep apnea
167
Obstructive sleep apnea increases the risk of...
-Myocardial infarction
-Stroke
168
The location of ___ on the tongue and lateral fat pads may narrow the airway during sleep-related breathing disorders
Fat
169
If someone has a more narrow ____, they are at higher anatomical risk for sleep-related breathing disorders
Pharynx
170
Critical factors in the development of sleep-related breathing disorders:
-Fat distribution
-Pharyngeal anatomy
-Arousal threshold
-Response to apnea
171
With sleep-related breathing disorders, there is a problem with the response to increased ___; a very large level is required to stimulate respiration
CO2
172
With ____, there is no airflow for 10 or more seconds
Apnea
173
____ is a decrease in airflow of 50% or more accompanied by 3 or more % drop in SaO2
Hypopnea
174
Apnea Hypopnea Index is calculated by...
(# apneas + # hypopneas) / hour sleep
175
AHI of 5-15 per hour would indicate ___ ___ ___ ___
Mild Obstructive Sleep Apnea
176
AHI of 15-30 would indicate ___ ___ ___ ___
Moderate obstructive sleep apnea
177
AHI over 30 would indicate ___ ___ ___ ___
Severe Obstructive Sleep Apnea
178
____, also known as a sleep study, is a comprehensive test used to diagnose sleep disorders
Polysonmography
179
It is now easier for sleep disorders to be diagnosed because of ____
Telehealth (home sleep test, wireless data transfer, determine pulmonary artery pressure for therapy)
180
What are non-invasive options to improve sleep apnea?
-Weight loss
-Positioning (off back)
-Pneumatic air splinting (GOLD STANDARD)
-Oral appliance to thrust jaw forward
-Medications
181
What are some examples of pneumatic air splinting?
-CPAP
-VPAP
-APAP
182
What are two examples of invasive options for sleep apnea treatment?
-Surgical alteration of tongue/airway
-Hypoglossal nerve stimulation
183
Pneumatic air splinting helps by adding ___ ____ delivered by mask to keep the airway open
Positive pressure
184
Pneumatic air splinting is noninvasive and highly ____
Effective
185
What does CPAP stand for?
Continuous positive airway pressure
186
With CPAP, there is the ____ pressure on inspiration and expiration
Same
187
What does VPAPP stand for?
Variable positive airway pressure
188
With VPAP, pressure ____ and can be less with expiration
Varies
189
What does APAP stand for?
Adaptive positive airway pressure
190
APAP adjusts volume to patient's ___ ___
Tidal volume
191
APAP avoids ___ ___ to set pressure
Titration study
192
What are some examples of mask types?
-Full face mask
-Nose mask
-Nasal pillow
193
___-___% of people abandon pneumatic air splinting within the 1st weeks
10-15
194
Only ___-___% of people are adherent long term
20-40
195
There has been no clear improvements past ___ years despite technical advances, behavioral interventions, and telemonitoring systems
20
196
What does a mandibular jaw advancement do for a patient?
-Pulls lower jaw forward
-Repositions tongue
-Opens airway
197
A mandibular jaw advancement has been shown to work with an apnea hypopnea index of ___ ___, but there is limited data to show improvement with apnea hypopnea index of severe
Mild moderate
198
In a randomized crossover study, it was shown that the CPAP is more ____ while the mandibular jaw advancement was used more ____
Effective; frequently
199
If symptoms of sleep apnea persist, recommend a medication called ____-___
Solriamfetol (Sunosi)
200
Medication doesn't improve the apnea, but helps patients ____ better
Sleep
201
In sleep, the muscles of the ___ relax, which obstructs the airway
Pharynx
202
____ position is a major factor in sleep apnea and the base can fall back and block the airway
Tongue
203
What are the three parts of the new technique to stimulate the hypoglossal nerve during sleep?
-Impulse generator
-Sensor of intercostal muscle
-Stimulator attached to hypoglossal nerve
204
What is the name of one hypoglossal nerve stimulator?
INSPIRE
205
If symptoms of sleep apnea persist, a ____ alteration of the airway/tongue can be done
Surgical
206
What are three consequences of sleep apnea?
-Cardiovascular disease risk
-Impaired glucose metabolism (high T2D risk)
-Behavioral issues (memory, attention, sleepiness, fatigue, learning difficulties)
207
With obstructive sleep apnea, there is attempt to breathe, but with ____ ____ ____, there is no respiratory drive
Central sleep apnea
208
Central sleep apnea may cause _____ ____ ____ that may be adaptive due to increased CO
Severe heart failure
209
Management of central sleep apnea includes...
-Heart failure therapies
-CPAP (to prevent apnea)
210
A recent trial showed that there is increased mortality in someone with central sleep apnea if they have an ejection fraction less than ___%
40%
211
Respiratory ____ begins with respiratory insufficiency/arrest/failure (RIAF)
Decomposition
212
Respiratory compromise is a ____ disorder
Progressive
213
Respiratory compromise type I is...
Hyperventilation Compensated Respiratory Distress
214
Respiratory compromise type I can be caused by...
-Sepsis
-CHF
-PE
215
Respiratory compromise type II is...
Progressive Unidirectional Hypoventilation (CO2 Narcosis)
216
Respiratory compromise type III is...
Sentinel Rapid AIrflow/SpO2 Reduction to Precipitous Fall
217
Oxygenation and ventilation are two ____ processes
Distinct
218
____ is the process of getting oxygen to the tissues and get be measured with oximetry
Oxygenation
219
____ is the process of eliminating CO2 from the body and can be measured using capnography
Ventilation
220
Partial pressure of arterial CO2 (PaCO2) measures CO2 dissolved in the ___ ___
Arterial plasma
221
Partial pressure of the end-tidal COs (PetCo2) measures CO2 at ___-___
End-exhalation
222
The PaCO2-PetCo2 ____ is established by comparing the two values (ABG to end-tidal volume)
Gradient
223
Usually, the PaCO2-PetCo2 gradient is less than ____ mmHg since PetCo2 is usually 2-5 mmHg lower than PaCO2
6
224
Capnometry gives a ____/____ measurement
Percent/numeric
225
Capnography gives a ___ and ___
Measurement and waveform
226
____ ____ gives a numerical value for end-tidal CO2 (EtCO2)
Wave capnography
227
With wave capnography, ___ ___ is sampled directly from the airway
Respiratory rate
228
With wave capnography, there is a ___ ___ for each breath
CO2 waveform
229
It is sometimes said that waveform capnography is the ___ of respiration
EKG
230
The ___ ___ test is a test for risk factors of sleep apnea; a score of 3 or more indicates high risk
STOP BANG
