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Pathology Final Exam > Pulmonary Pathophysiology- Obstructive Disease > Flashcards

Pulmonary Pathophysiology- Obstructive Disease Flashcards

1
Q

What is the premise behind obstructive diseases?

A

diseases of respiratory tract that obstructs airflow out

affects both ventilation (RR) and gas exchange (O2 sat)

“tennis court worth of air getting out of a one inch hole”

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2
Q

Besides decrease in bronchial lumen size what else happens to increase resistance?

A

increased mucus production, inflammation of mucosal lining, spasm of smooth muscle

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3
Q

What does hyperinflation do to the normal elastic recoil?

A

this is lost due to the obstructive disease process, this leads to collapsing of bronchial walls

both of these processes lead to contribute to the trapping of air

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4
Q

How does hyperinflation affect the rest of the respiratory process?

A

body has to work harder to get in air

diaphragm collapses and becomes less efficient so accessory muscles begin to kick in

higher RR leads to less efficient exchange

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5
Q

What happens to the alveoli during obstructive disease?

A

the alveoli receive less air or PAO2, this lack of gas exchange leads to less O2 in arteries to the rest of the body and CO2 builds up (hypercarbia)

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6
Q

What is minute ventilation?

A

RR x Vt

Vt goes up first

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7
Q

Why would it be a problem if RR went up before Vt?

A

leads to SOB and other symptoms, less efficient for gas exchange

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8
Q

What does PFT stand for?

A

pulmonary function testing

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9
Q

What are normal PFT values based off of?

A
  1. age- decreased predicted normal values as you age
  2. Height- taller people have larger lungs and therefore larger lung volumes
  3. Sex: males have larger lungs
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10
Q

What is tidal volume?

A

depth of breath, total volume of air moved on inspiration or expiration over a minute divided by the RR

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11
Q

What is residual volume?

A

volume of air that remains in the lung after a forceful expiration

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12
Q

What is total lung capacity?

A

maximum volume to which the lungs can be expanded, sum of all other values

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13
Q

What is the RV/ TLC ratio?

A

typically about 10-20%

higher percent denotes obstructive disease

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14
Q

What is vital capacity?

A

full inhalation and exhalation (ERV, IRV, VT)

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15
Q

What is forced vital capacity? (FEV)

A

maximum volume of air a person can exhale forcefully as quickly as possible

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16
Q

What is forced vital capacity in 1 second? (FEV1)

A

volume forcibly exhaled in one second

excellent predictor of obstructive disease

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17
Q

What is the FEV1/FVC ratio?

A

typically 70-80% of FEV should be exhaled in one second

will decrease in obstructive disease

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18
Q

What is the diffusion capacity (DLCO)?

A

carbon monoxide is inhaled then the patient inhales and exhales and how much comes out

reported as a percentage of predicted values (0-100%)

lower the percentage worse the diffusion capacity

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19
Q

Why could DLCO be decreased?

A

thickening of alveolar walls, decreased surface area for diffusion, decreased hemoglobin concentration in blood (anemia)

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20
Q

In general how do PFT’s look in obstructive diseases?

A

certain volumes increased (TLC and RV) due to hyperinflation)

all flows decrease (FEV, FEV1, ratio)

DLCO- diminished

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21
Q

What is the leading cause of COPD?

A

smoking, 4th leading cause of deaths in America

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22
Q

Which case of COPD is more common?

A

chronic bronchitis

23
Q

What is the definition of chronic bronch.?

A

persistent cough productive of excessive amounts of sputum for 3 consecutive months in 2 consecutive years

caused by smoking and usually in men over 40 years old
10-15% of adults have it

24
Q

What is the pathogenesis of CB?

A

smoking, environmental pollutents and fumes are thought to cause an inflammatory response, however exact trigger

possibly genetics or tolerance to pathogens

25
After the inflammatory response begins what happens in CB?
the mucus secreting glands increase in number and are enlarged
26
What does this increase of glands result in?
decrease in bronchial lumen, decrease in number of cilia, increase in smooth muscle, atrophy of cartilage in the bronchial wall, increase mucus to get rid of irritants
27
In CB what two things lead to air trapped in lungs?
decreased diameter of airways from mucus and atrophy or cartilage leads to floppy airways and collapsed airways
28
In CB what is usually seen on a chest X-ray?
increased markings on bronchi and airways hyperinflation
29
What is a ventilation/ perfusion test?
measures how much isotope gets into alveoli (vent) and measures blood flow into lungs (perfusion) mismatch of these two in CB
30
What are signs and symptoms of CB?
DOE, muscle weakness, increased cough, increased mucus, decreased lateral costal expansion, cyanosis, wheezing or crackling to auscultation
31
What is pulmonary emphysema?
abnormal and permanent enlargement of structures distal to terminal bronchioles, this leads to loss of elastic recoil and collapsed airways leading to airway obstruction although larger area less is for gas exchange
32
What is the pathogenesis of PE?
overabundance of proteolytic enzymes or lack of enzyme inhibitors and they then destroy the elastic tissue of the walls of alveoli most common cause- smoking
33
What happens to both perfusion and ventilation in PE?
both are impaired b/c underlying capillaries beds are also destroyed
34
In PE what causes air to be trapped?
loss of elastic recoil and loss of radial traction
35
What is seen on an X-ray for PE?
marked destruction of lung tissue, hyperinflation
36
What are signs and symptoms of PE?
DOE, increased A-P diameter of chest, decreased lateral costal expansion, distant or decreased breath sounds
37
What is bronchiectasis?
irreversible, abnormal dilation of bronchus usually occurs after infection, aspiration, tumors or foreign bodies prominent in : cystic fibrosis, immotile cillia syndrome and kartagener's syndrome
38
What is pathogenesis of bronchiectasis?
severe inflammation or infection cause there to be a mucus buildup and block airway distally and the cycle continues until mucus gone
39
What is pathophysiology of bronchiectasis?
bronchus becomes scarred from chronic inflammation, this replaces smooth muscle and along with mucus obstructs airways also increased blood vessels to the area causing hemoptysis (coughing blood)
40
What are the PFT's with bronchiectasis?
minimal changes with acute bronchiectasis but over time looks similar to COPD
41
What does a chest Xray look like for bronchiectasis?
increased markings and dilation of the bronchi and mucus plugging, hyperinflation atelectasis- seen distal to mucus plugging
42
What is a sputum culture and how does it relate to bronchiectasis?
a sample of the mucus is taken out and they let it grow to see what type of bacteria is growing and what antibiotic is needed
43
What are signs and symptoms of bronchiectasis?
DOE, increased cough, increased sputum, hemoptysis, clubbing
44
What is clubbing?
due to hypoxia finger nails don't grow out but instead become rounded they are thinner are proximal to DIP and thicker distal to DIP
45
What is one different treatment of bronchiectasis than other COPD's?
airway clearance to get rid of mucus
46
What is asthma?
characterized by smooth muscle reactivity or constructing due to an external or internal stimuli so hard getting air out
47
What is pathogenesis of asthma?
unknown trigger but theories include: 1. abnormal regulation of smooth muscle tone 2. autonomic control of smooth muscle is impaired 3. inflammation mediators effect smooth muscle of airway
48
What is extrinsic asthma?
acute episode from a stimulus outside of body, most common is allergens this stimulus combines with IgE in the airways triggering smooth muscle contraction
49
What is intrisic asthma?
caused from factors within body, exercise or viral/bacterial infections
50
What is exercise induced asthma?
high HR over 90% MPHR, happens within 6-8 minutes of exercise can be from heat or cold
51
What is pathophysiology of asthma?
due to this smooth muscle contraction or spasm they hypertrophy over time which also caused increased mucus/edema this leads to decreased lumen size causing obstructing
52
What bronchodilator is usually given to patient up acute flare up?
Albuterol usually a 15% increase of FEV and FEV1 after BD given
53
Clinical signs of asthma?
DOE, increased tight cough/chronic cough, increased lateral and AP costal, stridor (high-pitched musical breathing sound)
54
What is a peak flow meter?
a calibrated instrument used to measure lung capacity in monitoring breathing disorders such as asthma.

Pathology Final Exam (4 decks)

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