Respiratory System

Question 1

Define Dysnpea

Answer 1

Discomfort in breathing

Question 2

Define Cough

Answer 2

Irritant receptors in airway

Question 3

Define abnormal sputum

Answer 3

Changes in amount, color or consistency

Question 4

Define Hemoptysis

Answer 4

Blood stained sputum

Question 5

Define Cyanosis

Answer 5

Bluish discoloration of skin and mucous membranes due to increased amounts of deoxygenated hemoglobin in the blood

Question 6

Define Clubbing

Answer 6

Selective enlargement of one digit

Question 7

Hypercapnia, what is it caused by

Answer 7

Increased CO2 in arterial blood

Hypoventalation of the alveoli, decreasing the ability/drive to breathe

Question 8

Define Hypoxemia

Answer 8

Reduced oxygenation of arterial blood

Question 9

Four defects that cause hypoxemia

Answer 9

1 Oxygen delivery to alveoli – Decreased oxygen in air/decreased ventilation

2) Diffusion of oxygenated blood from alveoli into blood
a) Balance between alveolar ventilation (V) and perfusion (Q) (the amount of blood perfusing the alveolar capillaries (V/Q match). A mismatch of these two factors is the most common cause of hypoxemia.
b) Decreased diffusion across the alveolocapillary membrane (due to thickened membrane brought about through edema, or fibrosis)
3) Blood flow to the alveoli, decreased by blood flow physically bypassing the lungs, due to anatomicalright to left shunting (e.g., heart defects)

Question 10

What is V/Q

Answer 10

Ventilation and Perfusion

Question 11

What is High/Low V/Q

Answer 11

Low - Inadequate ventilation of well-perfused area of lung (asthma)
Blood moving through unventilated parts of the lung
High – Inadequate perfusion of well-ventilated area of lung (pulmonary embolism)
Wasted ventilation

Question 12

Define acute respiratory failure

Answer 12

Inadequate gas exchange (low O2, higher CO2 and ph)

Question 13

Acute respiratory failure causes

Answer 13

Injury to lungs, airway, chest wall, brain, spinal cord

Question 14

Acute respiratory failure is caused by what medical procedures

Answer 14

CNS, thorax or upper abdomen.

Question 15

Acute respiratory failure problems (four) caused by medical procedures

Answer 15

Atelectasis, pneumonia, pulmonary edema and pulmonary embolism

Question 16

2 types of support for acute respiratory failure and in what situation each would be used

Answer 16

Hypoxemic - inadequate exchange of oxygen across alveoli-capillary membrane, and individual must receive supplemental oxygen therapy.
Hypercapnic – problem with ventilation and individual must receive ventilatory support.

Question 17

What does chest wall restriction cause

Answer 17

Results in a decrease in tidal volume

Question 18

3 general conditions can give rise to chest wall restriction and give two examples of diseases that can result in restriction of the chest wall

Answer 18

Chest wall is deformed, traumatized, immobilized or heavy from the accumulation of fat.
Eg: grossly obese, neuromuscular diseases such as poliomyelitis, muscular dystrophy .

Question 19

Define Flail Chest

Answer 19

Fractures of several consecutive ribs – instability of chest wall. Opposite of normal breathing (goes in when inhaling, goes out when exhaling)

Question 20

Define pneumothorax and its effect on the lung

Answer 20

The presence of air or gas in the cavity between the lungs and the chest wall, causing collapse of the lung.

Question 21

Define pleural effusion how it usually occur

Answer 21

Presence of fluid in the pleural space.

Usually through migration of fluid through walls of capillaries bordering the pleura

Question 22

Define empyema and how it can occur

Answer 22

Infected pleural effusion

Complication of pneumonia, surgery

Question 23

What is restrictive lung disease

Answer 23

Decreased compliance of lung tissue (it takes more effort to expand the lungs during inspiration, which increases the work of breathing)

Question 24

What causes does restrictive lung disease cause and it’s end result

Answer 24

Dyspnea, increased respiratory rate and decreased tidal volume
Results in less oxygen transport into the blood which leads to hypoxemia

Question 25

Describe atelactasis (a type of restrictive lung disease)

Answer 25

Collapse of lung tissue, by external compression (fluid in pleural space, tumor, obstructive airways)

Question 26

Causes/Clinical manifestations of atelactasis

Answer 26

Tends to happen after surgury (patients in pain, breathe shallowly)
Clinical manifestations: dyspnea, cough, fever, leukocytosis

Question 27

What are suggestions that patients should take when they have atelactasis

Answer 27

Post-surgery patients advised to breathe deeply, become ambulatory asap, and change positions frequently when lying down.

Question 28

Describe bronchiectasis, its causes and clinical manifestations

Answer 28

Permanent dilation of bronchi
Caused by chronic inflammation of bronchial wall and permanent dilation
Clinical manifestations include: chronic cough, recurring lower respiratory tract infection, production of purulent sputum (cupfuls), hemoptysis and clubbing of the fingers (due to chronic hypoxemia).

Question 29

Define pulmonary edema, its most common cause, and its clinical manifestations

Answer 29

Excessive water in the lungs.
Most common cause is left-sided heart failure. Failure of left ventricle causes increased filling pressure, which causes back-up of blood in lungs, increasing pressure in lung capillaries. When this exceeds osmotic pressure of lung capillaries, fluid leaves capillaries and collects in interstitial space. When there is too much fluid for lymph system to collect, edema occurs. Fluid will move into the alveoli.
Clinical manifestations: dyspnea, increased work in breathing

Question 30

Define acute respiratory distress syndrome (ARDS) and give 3 causes, and its clinical manifestations.

Answer 30

Acute lung inflammation and injury to the alveolocapillary membrane, leading to severe pulmonary edema and hypoxemia.
Caused by sepsis, trauma, pneumonia, drug overdose, smoke inhalation.
Inflammatory cells release growth factors, resulting in the growth of connective tissue (fibrosis), which destroys the alveoli after about 1 week.
Clinical manifestations include: marked dyspnea, rapid, shallow breathing.

Question 31

What are obstructive lung diseases due to

Answer 31

Due to airway obstruction that is worse with expiration–emptying of the lungs is slowed

Question 32

What are the unifying symptom and sign of COPD?

Answer 32

Wheezing

Question 33

What is COPD

Answer 33

COPD is Chronic obstructive pulmonary disease (COPD)

Question 34

Define Asthma

Answer 34

A chronic inflammatory disorder to the bronchial mucosa that causes hyperresponsiveness and constriction of the airways.

Question 35

Describe the early response stage of an asthma attack and clinical manifestations

Answer 35

Usual type I hypersensitivity response: exposure to the bronchial mucosa activates B cells (plasma cells) to produce IgE which complexes with mast cells. Further exposure cross-links the IgE, causing the mast cells to release a host of chemicals, which cause vasodilation, increased capillary permeability, mucosal edema, bronchial smooth muscle contraction and mucous secretion.
Chest constriction, expiratory wheezing, dyspnea, tachycardia, coughing.

Question 36

Describe the 4 steps in the late response stage of an asthma attack.

Answer 36

Begins 4-8 hours after the early response.
1) Releasing inflammatory chemicals - Chemokines released by cells in early response call other inflammatory cells (neutrophils, eosinophils and lymphocytes) to the area. Inflammatory chemicals released by these cells cause further bronchospasm, edema and mucous secretion.
2) Cell damage + mucous
Damage from these chemicals occurs to ciliated epithelial cells. Mucous accumulates and cellular debris forms plugs in the airways.
Untreated inflammation can lead to long-term airway damage that is irreversible
3) The obstructed airway makes it more difficult to expire, causing air to be trapped in alveoli, increasing alveolar gas pressures. This causes decreased perfusion of blood over the alveoli (capillaries collapse), leading to hypoxemia without CO2retention. The hypoxemia leads to hyperventilation, causing respiratory alkalosis.
4. Impairment of respiratory muscles = respiratory acidosis
–The continued obstruction of airways increases air trapping (incomplete expirations), which hyperexpands the lungs and thorax, decreasing the tidal volume.
–At this point, CO2levels will rise, leading to respiratory acidosis, and the situation is life-threatening if treatment does not reverse the process quickly (mechanical ventilation may be required).
–Mainstays of treatment are avoidance of allergens, and inhalation

Question 37

Define chronic bronchitis

Answer 37

Hypersecretion of mucous and chronic cough for at least 3 months of the year for at least 2 years

Question 38

Development of bronchitis

Answer 38

Airway becomes inflamed with irritants, edema occurs along with thick mucous.
Continuous inflammation leads to increased in size/number of mucous glands in the airway epithelium.
Continued inflammation causes netrophils and and macrophages which release proteases which hair the ciliated epithelial cells. Ciliary cells are impaired, mucous not cleared. Airways constricted by thickened bronchial wall and mucous. Airways are narrowed, which makes it harder to exhale (airways are narrowed during this part of the respiratory cycle) Obstruction leads to hypoxemia. Eventually airways collapse in early expiration, causing air trapping. Expands thorax making breathing more difficult.

Question 39

Treatment of bronchitis

Answer 39

No smoking, chest physical therapy, antibiotics, steroids.

Question 40

Define emphysema

Answer 40

Abnormal permanent enlargement of gas-exchange airways accompanied by destruction of alveolar walls without obvious fibrosis.

Question 41

What is the difference between the physiological causes of emphysema and bronchitis?

Answer 41

Changes in the lung tissue, rather than from mucous production and inflammation, which is the case with chronic bronchitis.

Question 42

What are two causes of emphysema?

Answer 42

Can be inherited or through pollution, smoking.

Question 43

Describe the development of emphysema.

Answer 43

1. Occurs as a result of destruction of alveolar septae (brought about through inflammation caused by cigarette smoke, for e.g.), which eliminates part of capillary bed and increases volume of acini.
2. This produces large air spaces within the lungs, and on the surface of the lungs, next to the pleura. These air spaces can not function in gas exchange, which increases hypoxemia.
3. Damage from inflammation includes a loss in the elastic recoil of the lung tissue, which results in expiration becoming difficult, thus trapping air in the lungs.
4. This hyperexpands the thorax, making it difficult to breathe, causing hypoventilation and hypercapnia.

Question 44

What is pulmonary hypertension, disease example and result

Answer 44

Elevated mean pulmonary artery pressure which is a serious complication of acute/chronic pulmonary disorders. If chronic, can result in fibrosis and hypertrophy of smooth muscle, pulmonary artery stiffens and increase hypertension.

Question 45

Cor pulmonale

Answer 45

Right ventricle enlargement caused by pulmonary hypertension (higher than normal pulmonary artery pressure. Results in peripheral edema.

Question 46

Define bronchiolitis and give its cause

Answer 46

Inflammation of small airways caused by virus.

Question 47

Define epiglottis, and give its cause

Answer 47

Caused by bacterial infection