Respiratory Pathophysiology

Question 1

Requirements for Proper External Respiration

(4)

• Pulmonary _____ can involve abnormalities of one or more of these requirements
• Hypoxia:
• Hypoxemia:

Answer 1

Ventilation

Gas Exchange

Gas Transport

Tissue Extraction/Deposition

• disorders
• Low oxygen lvls (usually referring to tissue)
• Low oxygen content of blood

Question 2

Abnormal Ventilation

(3)

Under first category (5)

Answer 2

• Pleural Abnormalities
  
  • Pneumothorax
  • Open Pneumothorax
  • Tension Pneumothorax
  • Spontaneous Pneumothorax
  • Hemothorax or Pleural Effusion
• Restrictive Lung Disease
• Obstructive Pulmonary Disease

Question 3

Abnormal Ventilation (Notes)

• Restrictive Lung Disease:
• Obstructive Lung Disease:

Answer 3

• reduced elasticity of lungs and increased respiratory effort
• any disease that results in airway narrowing -> reduces ability to expel air -> air trapping

Question 4

Abnormal Gas Exchange

(4)

Answer 4

Adult Respiratory Distress

High Altitude - reduced atmospheric PO2

Pulmonary edema

Ventilation-Perfusion Mismatch

Question 5

Abnormal Gas Exchange (Notes)

• ARDS: injury like _____ damages airway/alveolar capillary junction -> _____ -> ___ accumulation -> impaired gas exchange
• High altitude: ____ PO2 -> effects ____ gradient that drives gas exchange
• Ventilation Perfusion Mismatch: either your ____ lungs but can’t ventilate or can ____ but no perfusion (ie. PE)

Answer 5

• smoking -> inflammation -> fluid
• lower -> pressure
• perfusing, ventilate

Question 6

Abnormal Gas Transport

(1)

:when the fundamental problem is the oxygen _____ ability of blood (reduced ___, reduced ___, altered ____ of Hb)

CO Poisoning:

Answer 6

Anemic Hypoxia

: carrying, (rbc, hb, altereted quality)

: no reduced RBC or Hb, CO competes with O2 with a much higher affinity to binding sites of Hb

Question 7

Abnormal Tissue Extraction/Deposition/Utilization

(1)

: originates from the cells themselves

(1): ____ effect of impairing aerobic ____ so cells can’t use O2 (blocks (1) which is last step in (1))

Answer 7

Histotoxic Hypoxia

• Cyanide Poisoning: poisoning, metabolism, electron transport chain, O2 metabolism

Question 8

Traumatic Pneumothorax

= ____ common and usually caused by?

• Intrapleural space usually filled with ____ and NO ___ which has a slightly _____ pressure (___ than atmospheric and alveolar pressure)
• Result is a _____ lung and impaired ventilation
  
  • Puncture wound lets air __ and pleural fluid _____ w atmospheric pressure -> interrupted ____ _____/breaks glue and lung collapses
  • What happens when you inhale?
  • What happens when you exhale?

Answer 8

= most, traumatic injury such as knife/gunshot wound

• fluid, NO air, negative pressure (less)
• collapsed
  
  • ​in, equilibrates, surface tension
  • Thoracic cavity expands and pressure goes down and creates a pressure gradient for airflow -> air is sucked in “sucking chest wound”
  • Seals the wound

Question 9

Tension Pneumothorax

= When someone has an injury like a traumatic pneumothorax -> pressure is going to ____ through that ___ way valve

• Effects: _____ of heart and mediastinum, ______ of space of other lung
• Treatment: _____ inflate lungs until touching thoracic wall and then vaseline ____ to create and air tight ____ and restore ____ between lungs and chest wall

Answer 9

= build up, one way valve

• shifting, impingement
• mechanically, bandage, seal, contact

Question 10

Spontaneous Pneumothorax

=

• Etiology: pt has occult pulmonary ____ that has injured integrity of pleural membrane
• Prevalance in what type of people?
• Effects = lung collapses but no (1), why?
• Sx = _____ breathing, air ____

Answer 10

Spontaneous break in visceral pleura that causes collapse of lung

• disease
• young, healthy, even athletic men (20, 30, tall, frequently swimmers)
• NO TENSION PNEUMO bc not enough air is coming in through airway into affected lung and therefore is rare
• labored breathing, air hunger

Question 11

Pleural Effusion vs. Hemothorax

Hemothorax =

Pleural Effusion =

Tx =

Answer 11

Blood in thoracic cavity that starts to impinge on lungs (usually caused by traumatic injury)

Fluid accumulation in intrapleural space when abnormal turnover of intrapleural fluid: impairment of drainage

Drainage of blood or fluid by chest tube

Question 12

Impaired Gas Exchange

V/Q Mismatch (V = ___, Q = ___)

• Perfusion Obstructions (2)
• Ventilation Obstructions (3)

Answer 12

V = Ventilation, Q = Perfusion

• Pulmonary Embolus
• Tumor Obstruction (obsructing blood flow)
• Impaired ventilation mechanics
• Obstructive or restrictive pulmonary disease
• Tumor Obstruction (pressing on airway)

Question 13

V/Q Mismatch

Any V/Q Mismatch impairs ___ ____

• Equal V/Q Ratio = __
• Normal V/Q Ratio at rest = __ in lungs
• High Value V/Q Ratio =
• Low Value V/Q Ratio =

Answer 13

Gas Exchange

• 1
• 0.8
• Perfusion Obstruction (PE, tumor obstructing blood flow)
• Ventilation Issue

Question 14

Impaired Gas Exchange

Pulmonary Edema = excessive pulmonary capillary ___ ____

Causes (3)

Answer 14

Blood Pressure

• Hypertension
• Left-Sided Heart Failure
• Fluid Volume Overload

Question 15

Pulmonary Edema (Notes)

• Fluid volume _____ -> increased pulmonary cap __ -> ____ fluid into ____ space
  
  • Presentation: ___ ___ sputum, c_____
  • Reduced gas ____ and _____ of blood, potentially life-threatening
  • Tx (1)

Answer 15

• overload -> BP -> pushed, alveolar
  
  • pink frothy sputum, crackles
  • exchange, oxygenation
  • Diuretics

Question 16

Abnormal Gas Transport

Anemic Hypoxia

Carbon Monoxide Poisoning

• Carbon Monoxide: is a product of incomplete _____ or organic matter. It ____ to Hb at the __ binding site with an ____ over 200x stronger than O2.
• Can cause signficant _____ in blood oxygenation by reducing the Hb O2 __ saturation.
• The reduced oxygenation can be difficult to detect since ___ (blood gases) will be ____ and most pulse oximeters cannot differentiate btween ___hemoglobin and ___hemoglobin. Detection can be made through use of a?

Answer 16

• combustion, binds at O2 binding site, affinity
• reduction, %
• PaO2, normal, oxy and carboxy, pulse CO-oximeter

Question 17

CO Poisoning (Notes)

AKA when oxygen’s ____ ability of blood goes down

• CO binds to heme group on Hb with an affinity over 200x stronger than that of O2 (practically _____ binding) -> reduces oxygenation of blood overall
  
  • Difficult to diagnose bc CO is ___less, ___less, makes Hb ___ so person will either look ___ or ___
  • Pulse ox reflects light of O2 and CO on Hb in the same way, cbc ____, blood gas ____ bc PO2 (O2 is whats in plasma)
  • Early sx: H__/H_____ (haunted house)
  • Usually diagnosed by situation: found in car w ____

Answer 17

Carrying ability goes down

• irreversible binding
  
  • odorless, colorless, red, normal or flushed (not cyanotic)
  • normal, normal
  • HA, Hallucinations
  • vomit

Question 18

Obstructive vs. Restrictive Pulmonary Disease

• Obstructive Pulmonary Disease
  
  • ​Characterized by? (3)
  • Common Disorders (3)
• Restrictive Pulmonary Disease
  
  • ​Characterized by? (2)
  • Common Disorders (2)

Answer 18

• Obstructive
  
  • ​airway narrowing, air trapping, expiratory wheezing
  • Asthma, Acute and Chronic Bronchitis, Emphysema
• Restrictive
  
  • ​Decreased lung compliance, increased respiratory effort
  • Pulmonary Fibrosis, Infant Respiratory Distress Syndrome

Question 19

Restrictive Pulmonary Disease (Notes)

• Decreased lung ____, decreased ____ and more difficult to get it to expand
• Infant Respiratory Distress Syndrome =

Answer 19

• compliance, elasticity
• not enough pulmonary surfactant causes alveolar collapse which causes difficulty in expansion

Question 20

Measuring Lung Volumes and Function through Spirometry

• Pulmonary Function Tests (ie. spirometry) are performed to differentiate between?
  
  • Spirometry: mouthpiece that person breaths into - device can measure _____ of air moving in and out of lungs, also allows us to perform ___
  • Difficult when pt cannot be compliant: _____, adults with ____ _____

Answer 20

• between obstructive and restrictive pulmonary disease
  
  • volume, PFTs
  • children, cognitive impairment

Question 21

Lung Volumes we can measure through Spirometry

1. (1): Total volume of air that can occupy lungs (just under 6L) -> __ + __ (also cannot be measured by spirometry bc can’t measure __)
2. (1): Amount of air you can move in and out of your lungs
   
   • (1): volume of air left in lungs after max exhalation (Difference between ___ and ___) _____ measure using spirometry
3. (1): air moving in and out of lungs during normal restful breathing (a small fraction of __ in healthy individual) ~___mL

Answer 21

1. Total Lung Capacity -> VC + RV, RV
2. Vital Capacity
   
   • ​Residual Volume, TLC and VC, cannot measure
3. Tidal Volume, fraction of VC, ~500mL

Question 22

Lung Volumes we can measure through Spirometry

1. (1): max volume person can move into their lungs
2. (1): Difference betwen IC and TV (how much more air can you move in after a normal restful breath)
3. (1): how much air you can move out after normal exhalation (much ____ than inspiratory reserve)
4. (1): amount of air left in lungs after restful exhalation

Answer 22

1. Inspiratory Capacity (IC)
2. Inspiratory Reserve Volume (IRV)
3. Expiratory Reserve Volume (ERV) smaller than IRV
4. Functional Residual Capacity (FRC)

Question 23

Residual Volume

• On forceful expiration - abdominal and intercostal muscles contract to get thoracic cavity as small as possible -> creates high intrathoracic pressure that causes _____ airways to _____ and ___ air _____ of it
• Cannot measure ___ and ____ using Spirometry bc you can only measure air that you can move and out using spirometry

Answer 23

• unsupported airways collapse and trap air downstream of it
• RV and TLC

Question 24

Pulmonary Function Tests: Forced Expiration

Forced Expiratory Test =

• ​Forced exhalation causes increase pressure in chest ____ and to a ____ extent (those unsupported airways (little straws) are going to collapse _____ -> increased _____ volume

Forced Vital Capacity (FVC)

Forced Expiratory Volume (FEV1) =

Normal lung function FEV1 = ___% of FVC

• ​If FEV1 is <85%, what does that suggest?

Answer 24

have person slowly take in as big of a breath as they can and ask them to forcefully exhale as hard and fast as they can (maximal inhalation -> forceful exhalation)

• faster, greater, SOONER -> increased residual volume

Forced expiratory volume at 1 second (volume of air you get out within 1st second)

85%

• suggests that small airways are closing earlier -> obstructive lung disease (airway narrowing causes collapse sooner)

Question 25

Volume Changes in Restrictive Lung Disease (Lung is less elastic) ## Footnote **FEV1 and FVC usually \_\_\_\_\_** **Problem is more about _______ capacity** * Inspiratory Capacity = * Tidal Volume = * Vital Capacity = * Inspiratory Reserve Volume = * Total Lung Capacity = * ERV = * Residual Volume =

Answer 25

**Normal** **Inspiratory** * decreases * same * decreases dt decreased IC * decreases * decreases * normal * same

Question 26

Volume Changes in Obstructive Lung Disease (Airway narrowing/collapse sooner -\> Air Trapping) ## Footnote **FEV1 and FVC =** **What volume is effected more severely?** **Residual Volume =**

Answer 26

**Decreased significantly** **Expiratory capacity** Increases (air trapping) -\> Chronic hypercapnia (CO2)

Question 27

Pulmonary Fibrosis ## Footnote **What type of lung disease?** **the development of excess ______ \_\_\_\_\_\_ tissue in the lungs (lung \_\_\_\_\_)** *Some common causes:* * Inhalation/exposure to ______ or _______ pollutants (a\_\_\_\_, d\_\_\_\_, etc) * Can be a complication of certain disorders involving chronic _____ especially of _____ tissue (scl\_\_\_\_\_, systemic ______ erythmatosus, ______ arthritis, etc) * Certain medications (a\_\_\_\_\_\_, m\_\_\_\_\_\_, etc) * ______ infections * _______ therapy to chest

Answer 27

**Restrictive Lung Disease** **fibrous connective,** scarring * environmental, occupational (asbestos, dust) * inflammation, connective (scleroderma, lupus, rheumatoid) * amiodarone, methotrexate * repeated * radiation opaque appearance from scar tissue (collagen replacing elastin)

Question 28

Major Obstructive Lung Diseases (3) * All create airway ______ but different in nature * COPD reserved for severe forms of _____ + \_\_\_\_\_\_

Answer 28

**Asthma** **Bronchitis** **Emphysema** * narrowing * bronchitis + emphysema

Question 29

Why asthma makes it hard to breathe ## Footnote In an asthmatic person, the muscle of the bronchiole tubes t\_\_\_\_ and th\_\_\_\_\_, and the air passages become _____ and \_\_\_\_-filled, making it difficult for air to move

Answer 29

tighten, thicken, inflamed, mucus filled

Question 30

Pathophysiology of Asthma ## Footnote _Made up of 2 arms_ 1. Suffering from **\_\_\_\_\_\_ \_\_\_\_\_\_** in lungs + 2. **\_\_\_\_\_\_** (irritants, allergens) that cause ______ during an acute \_\_\_\_\_ * Acute inflammatory response on top of chronic inflammation during attack -\> activation of Ig\_, Mast Cell ______ -\> vaso\_\_\_\_\_ -\> increased cap _____ -\> increased c\_\_\_\_\_ and _____ production -\> _____ of walls of airways * **\_\_\_\_\_\_\_ caused by WBC releasing ___ during acute inflammation** -\> acute and severe narrowing, constant state of ______ of airways

Answer 30

1. **chronic inflammation** 2. **Triggers, bronchospasm,** attack * Ige, Mast Cell Degranulation, dilation, permeability, congestion, mucus, narrowing * **Bronchospasm, ROS,** **hyperresponsiveness**

Question 31

Treatment of Asthma (Notes) ## Footnote * (2) meds * (2) Important reasons why we want to control chronic inflammation

Answer 31

* Meds to control chronic inflammation + rescue medication (bronchodilators) 1. Reduce risk of attacks 2. Reduce risk of fibrosis/scarring

Question 32

Bronchitis = * Unlike asthma, where inflammation leads to bronchospasm, inflammation in bronchitis leads to? * Mucus ______ cilia that line the airways and if you can't get mucus out -\> better environment for ____ to live and cause _____ \_\_\_\_\_\* 1. **Acute Bronchitis:** can occur from **(1)** that evolves into bronchitis (lasts 1-1.5m), typical characteristic of severe, **\_\_\_\_\_\_ \_\_\_\_\_\_** (usually productive) 2. **Chronic Bronchitis:** usually caused by chronic **\_\_\_\_\_ -\> malfunction/elimination of \_\_\_\_** -\> can't get mucus out and again frequent ____ and chronic \_\_\_\_

Answer 32

Inflammation of larger bronchiolar airways * congestion of airway with thickening and **increased mucus production**\* * immobilizes, bacteria, **frequent infection\*** 1. **upper respiratory infection, persistent cough** 2. **smoking, cilia, infections, cough**

Question 33

Patho of Chronic Bronchitis ## Footnote 1. Starts with (1) or (1) 2. _____ of airway epithelium 3. I\_\_\_\_\_\_ of inflammatory cells and release of _____ (neutrophils, macrophages, lymphocytes, leukotrienes, interleukins) 4. _____ bronchial irritation and inflammation 5. Chronic bronchitis (bronchial e\_\_\_\_, hypersecretion of \_\_\_\_\_, ______ malfunction, ______ colonization of airways) 6. Airway \_\_\_\_\_, air \_\_\_\_\_, loss of (1) for gas exchange. _____ exacerbations (\_\_\_\_\_, bronchospasm) 7. D\_\_\_\_\_, C\_\_\_\_\_, Hypoxemia, Hyper\_\_\_\_\_

Answer 33

1. tobacco smoke, air pollution 2. Inflammation 3. Infiltration, cytokines 4. Continuous 5. edema, mucus, ciliary, bacterial 6. obstruction, trapping, SA, frequent (infections) 7. Dyspnea, cough, hypercapnia

Question 34

Chronic Bronchitis (Notes) ## Footnote Main cause in the US? In other countires can be cuased by? If not treated what can it lead to?

Answer 34

**SMOKING** Air pollution can be so bad to cause it (no smoking cessation), frequent exacerbations can lead to **Emphysema**

Question 35

Emphysema Results from **chronic bronchitis -\>** **weakened and _____ airway sacs** **(\_\_\_\_ of lung tissue)** no longer participating in gas exchange The airway narrowing that is happening in emphysema is a **\_\_\_\_\_\_ NARROWING -\> LOSS OF ______ of AIRWAY SACS\*\***

Answer 35

**collapse (loss of lung tissue)** **FUNCTIONAL -\> LOSS OF INTERDEPENDENCE\* OF AIRWAY SACS**

Question 36

2 Routes of Emphysema ## Footnote 1. Primary Emphysema (1)**​** * **Trypsin =** * **Anti-Trypsin =** * What is happening in primary empyhsema? 2. (2) **Most \_\_\_\_\_\_** * **​​**How does this also effect protease activity?

Answer 36

1. Inherited a1 Anti-trypsin deficiency * **​**(protease) enzyme that breaks down protein in lungs so new protein can be made (normal turnover) * prevents over-digestion of protein in lungs * Protease activity out of control -\> progressive breakdown of lung tissue -\> primary emphysema 2. Smoking, Air pollution **MOST COMMON** * **​​**Chronic inflammatory process of bronchitis **alters the relationship between trypsin and anti-trypsin -**\> also enhancing activity of protease (breakdown of tissue)

Question 37

COPD (Notes) ## Footnote Bronchitis + Emphysema * Presenation: air \_\_\_\_\_, reduced gas \_\_\_\_\_ * Interventions: ____ expiratory breathing -\> to get more air out and improve air trapping * Common Manifestations * Body adapts to hypercapnia and CO2 is no longer the? * (1) becomes primary drive for breathing -\> peripheral chemoreceptors that don't stimulate breathing until O2 drops to ~\_\_mmHg (\_\_-\_\_%) -\> if you oxygenate pts above that lvl you eliminate their drive to breathe * Chronic Hypoxemia -\> _____ of fingernails, _____ of pulmonary vessles -\> pulm ___ -\> right sided ___ -\> dependent \_\_\_\_\_, congestion of \_\_\_\_, congestion of ___ tract (loss of \_\_\_\_) * Chronic _____ -\> a lot of energy goes to coughing -\> _____ arms and legs, ____ chest, use of ____ muscles

Answer 37

* trapping, exchange * slow * CO2 no longer primary drive for breathing * O2, 60 (90-92%) * clubbing, constriction, HTN, HF, edema, liver, GI (loss of appetite) * cough -\> skinny arms/legs, barrel chest, accessory