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Pathophysiology > Respiratory Disorders > Flashcards

Respiratory Disorders Flashcards

1
Q

What are the respiratory systems primary functions?

A

Gas exchange between atmosphere and blood, protection from inhaled pathogens and irritants, regulation of body pH, also vocalization/phonation

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2
Q

What structures make up the upper airways?

A

Nasal cavity, pharynx, larynx (above the vocal cords)

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3
Q

What structures make up the lower airways?

A

Larynx (portion below vocal cords), trachea, bronchi, bronchioles, alveoli

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4
Q

What is the mucociliary apparatus?

A

Located on larger airway portions, cilia on epithelium function to move mucus secreted by goblet cells up towards larynx to be removed

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5
Q

What is surfactant?

A

Phospholipid substance secreted by type II alveolar cells, lines alveoli to decrease surface tension, make it easier to inflate the lungs

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6
Q

What are the four steps of gas exchange?

A

Ventilation of the lungs, diffusion of oxygen from the alveoli into the capillary bed, perfusion of systemic capillaries with oxygenated blood, diffusion of oxygen from systemic capillaries into the cells

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7
Q

Is expiration a passive or active process?

A

Passive- but can become active when there is resistance or someone is trying to breathe at maximum capacity

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8
Q

What is the average V/Q ratio for lungs?

A

0.8, indicates the rate of blood flow across the alveoli is greater than the rate of ventilation

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9
Q

What would a high V/Q ratio indicate?

A

Not enough perfusion of a well-ventilated area, can occur in the apex of the lung or when pulmonary vessels are occluded

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10
Q

What would a low V/Q ratio indicate?

A

Not enough ventilation of a well-perfused area, can occur in base of lung, or with airway narrowing or obstruction

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11
Q

What is the role of the pulmonary aterioles?

A

Try to relax/constrict to direct blood to the ventilated areas

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12
Q

What is obstructive lung disease?

A

Causes difficulty on expiration, results in air trapping/dyspnea/SOB

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13
Q

What disorders are examples of obstructive lung disease?

A

Asthma, COPD, cystic fibrosis

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14
Q

What is restrictive lung disease?

A

Prevents lungs from fully expanding and interferes with proper inspiration

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15
Q

Which disorders are examples of restrictive lung disease?

A

Intrinsic (interstitial lung disease, adverse drug reaction) or extrinsic mechanisms (chest wall and neuromuscular disorders such as ALS, myasthenia gravis), interstitial lung disease (pneumonia, fibrosis, etc.) or injuries (obesity, scoliosis)

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16
Q

What differentiates asthma from other obstructive lung diseases?

A

Reversibility of obstruction (spontaneous or with treatment)

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17
Q

In general, what type of hypersensitivity reaction is asthma?

A

Type 1

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18
Q

Which interleukins do Th2 cells secrete in asthma?

A

IL-4, IL-5, IL-8, and IL-14

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19
Q

What is the role of IL-4?

A

Helps B cells differentiate into plasma cells, promotes class switching from IgG to IgE

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20
Q

What is the role of IL-5 in asthma?

A

Aids in recruitment of eosinophils

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21
Q

What is the role of IL-13 in asthma?

A

Enhances the secretion of fibroblasts, contributes to bronchoconstriction, works with IL-4 to cause IgE class switch

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22
Q

What type of response do Th1 cells cause?

A

Cell-mediated response (T cells)

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23
Q

What type of response do Th2 cells cause?

A

Humoral (B cells, antibodies)

24
Q

What occurs in the late response of asthma?

A

Recruitment of eosinophils, basophils, neutrophils, macrophages and Th2 cells, occurs 4-8 hours after attack and can persist/be severe

25
Q

What are leukotrienes?

A

Released along with histamine in late asthma response (have longer response), result in bronchoconstriction, recruitment of neutrophils and eosinophils, mucus secretion

26
Q

What do eosinophils do?

A

Release pro-inflammatory cytokines and cytotoxic mediators–promote vascular leakage, mucus hypersecretion, bronchoconstriction, and airway hyperresponsiveness

27
Q

What are the two phenotypes of COPD?

A

Chronic bronchitis and emphysema

28
Q

What is the number one risk factor for COPD?

A

Exposure to tobacco smoke

29
Q

What is primary emphysema?

A

Caused by inherited mutation in A1-antirypsin gene, usually found in young non-smokers

30
Q

What is A1-antitrypsin?

A

Protects lung tissue from proteolytic enzymes that break down elastic (released from immune cells)

31
Q

What is emphysema?

A

Chronic inflammatory condition characterized by abnormal permenant enlargement of gas-exchange airways accompanied by destruction of alveolar walls without obvious fibrosis

32
Q

What promotes airway inflammation in emphysema?

A

Inspired airway irritants

33
Q

What is chronic bronchitis?

A

Moreso inflammation of the bronchi vs. destruction of the alveoli, characterized by hypersecretion of mucus and a chronic, productive cough

34
Q

Alveolar destruction and air trapping result in what?

A

V/Q mismatch which results in hypoxia and hypercapnia, can lead to structural changes in pulmonary vasculature (including thickening of tunica intima and vascular smoother muscle hyperplasia)

35
Q

What is cor pulmonale?

A

More often seen with chronic bronchitis and is known as R sided HF secondary to pulmonary artery hypertension= hypertrophy of RV,

36
Q

What are typical causes of acute COPD exacerbations?

A

Viral culprits (RSV, influenza) mainly, sometimes bacterial

37
Q

What are the subtypes of non-small cell lung cancer?

A

Squamous cell carcinoma (30%), adenocarcinomas (35-40%), large cell carcinomas (10%)

38
Q

What are the characteristics of squamous cell carcinomas?

A

Arise in large airways, have non-productive cough and hemoptysis, remain well localized and metastasize later on, can cause obstruction

39
Q

What are the characteristics of adenocarcinoma?

A

Peripherally located, common in NON-smokers, can be asymptomatic

40
Q

What are the characteristics of large cell carcinoma?

A

Centrally located, tumor cells large/undifferentiated, grows rapidly and metastasizes early, poor prognosis, diagnosed by exclusion (d/t non specific nature)

41
Q

What are the characteristics of neuroendocrine tumors/ small cell carcinomas?

A

15% of lung cancers, centrally located, correlation with cigarette smoking, metastasize early and spread rapidly, arise from neuroendocrine cells**, poor prognosis

42
Q

Is latent TB infectious?

A

No

43
Q

What is important to consider about the TB skin test?

A

Cannot differentiate b/t active and latent disease, produces type IV hypersensitivity if individual has ever been exposed

44
Q

What is the most common etiologic agent of pneumonia?

A

S. Pneumoniae (community acquired), P. Aeruginosa (HAP) and P. Jirovecii (in immunocompromised)

45
Q

What is the first point of contact in pneumonia?

A

Alveolar macrophages

46
Q

What is tidal volume?

A

Amount of air that moves in/out of the lungs

47
Q

Where is respiratory smooth muscle found?

A

In conducting airways (structures outside of lungs)

48
Q

How is air expelled from alveoli?

A

Through elastin

49
Q

What covers the lungs?

A

Visceral pleura

50
Q

What lines the inside of the thoracic cavity?

A

Parietal pleura

51
Q

What organs does cystic fibrosis affect?

A

Airways, digestive tract, and reproductive organs

52
Q

What are the effects of cystic fibrosis on the lungs?

A

Mucus plugging (increased numbers and size of goblet cells, alteration of mucus, and impaired mucociliary clearance) , chronic inflammation, chronic infection of small airways

53
Q

Why is the mucus in CF dehydrated and viscous?

A

Defective chloride secretion, excess sodium absorption

54
Q

Which immune cell is present in great numbers in CF?

A

Neutrophils–release damage oxidants and proteases (ex: elastase)= airway remodelling, bronchiectasis

55
Q

What are the typical diagnostic measures for CF?

A

Hx of CF in sibling, + newborn screen and lab evidence of abnormality in CFTR gene, immunoreactive trypsinogen blood test and sweat chloride test

56
Q
A
57
Q
A

Pathophysiology (12 decks)

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