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Advanced Pathophysiology > Unit 4 > Flashcards

Unit 4 Flashcards

1
Q

Consists of nasopharynx and oropharynx, which helps filter and moisturize air that is inhaled

A

Upper conducting airways

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2
Q

Begin at level of trachea and connects larynx to bronchi

A

Lower conducting airways

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3
Q

What does not occur in the conducting airways?

A

Gas exchange

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4
Q

Primary gas exchange units of lung

A

Alveoli

can also occur in bronchioles

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5
Q

The alveoli have two types of epithelial cells:

A

I- provides structure (elastin)
II- secretes surfactant
*also has alveolar macrophages to remove foreign material to lymph

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6
Q

These type of diseases/illnesses increase thickness of respiratory membranes, affecting diffusion of gases across the membrane

A

Fibrosis, interstitial edema, or pulmonary edema

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7
Q

This type of disease results in decrease in surface area of respiratory membrane, resulting in decreased alveolar gas exchange

A

Emphysema

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8
Q

The mechanical movement of gas (air) into and out of the lung

A

Ventilation

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9
Q

How to measure alveolar ventilation

A

ABG to assess PaCO2

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10
Q

Reduces surface tension by forming a monomolecular layer between the fluid lining the alveoli and air in the alveoli- contributes to functional residual capacity (FRC)

A

Surfactant

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11
Q

Measure of lung and chest wall distensibility (ease at which these structures can be stretched, determined by alveolar surface tension and elastic recoil of lung/chest wall)

A

Compliance

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12
Q

Increased compliance, lung/chest wall is abnormally easy to inflate and has lost elastic recoil

A

Emphysema (chronic overinflation of lungs)

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13
Q

Decreased compliance, lungs are stuff and difficult to inflate

A

PNA, edema, fibrosis, or adult respiratory distress syndrome (ARDS)

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14
Q

Reduced oxygenation of cells in tissues

A

Hypoxia

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15
Q

Reduced oxygenation of arterial blood

A

Hypoxemia

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16
Q

Most common cause of hypoxemia

A

Abnormal V/Q (ventilation-perfusion) ratio

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17
Q

Blood passing through the pulmonary circulation to be oxygenated

A

Perfusion

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18
Q

Ratio of airflow into the lungs divided by the pulmonary blood flow

A

Ventilation-Perfusion ratio

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19
Q

Delivery of air to some alveoli is obstructed (mucus or alveoli collapse from atelectasis), reduced oxygenation of alveoli

A

Decreased/low V/Q

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20
Q

Alveoli ventilation is normal but capillary perfusion is compromised (pulmonary embolus or MI)

A

High V/Q

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21
Q

Two major patterns of pulmonary dysfunction

A

Obstructive and Restrictive

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22
Q

Increased resistance to airflow as a result of caliber reduction in conducting airways (worse with expiration)

A

Obstructive Pulmonary Disease

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23
Q

3 most common forms of obstructive respiratory disorders

A

Asthma, emphysema, and chronic bronchitis

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24
Q

COPD consists of which two pulmonary disorders?

A

Emphysema and chronic bronchitis

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25
Q

Hallmark of obstructive pulmonary disease

A

Decrease in expiratory flow rate

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26
Q

Most common signs and symptoms of obstructive lung disorders

A

Dyspnea and wheezing

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27
Q

Maximum volume to which the lungs can be expanded

A

Total lung capacity (TLC)

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28
Q

Volume of air remaining (RV) in lungs after most forceful expiration is ________ in obstructive lung disease due to trapping of air during expiration

A

Elevated

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29
Q

Obstructive alteration characterized by spastic contraction of smooth muscle of bronchioles

A

Asthma

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30
Q

Obstructive disorder characterized by hyper secretion of mucus and chronic productive cough

A

Chronic bronchitis

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31
Q

Diagnosis of chronic bronchitis requires the following criteria….

A

Chronic productive cough for 3 consecutive months of the year for 2 consecutive years

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32
Q

Chronic bronchitis affects the following cells (2)

A

Goblet cells (mucus-producing cells in bronchi) and cilia (causing paralysis of cilia)

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33
Q

Distinguishing characteristic of chronic bronchitis

A

Chronic inflammation

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34
Q

Excess air in lungs due to loss of lung elasticity and reduction of alveolar surface area from destruction of alveolar walls and enlargement of air spaces distal to the terminal bronchioles

A

Emphysema

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35
Q

Amount of air that moves into and out of the lungs with each breath

A

Tidal Volume (TV)

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36
Q

Maximal amount of air that can be forcibly exhaled from the point of maximal inspiration

A

Vital Capacity (VC)

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37
Q

Volume of air remaining in the lungs at end-expiration

A

Functional Residual Capacity (FRC)

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38
Q

Total amount of air that the lungs can hold

A

Total Lung Capacity (TLC)

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39
Q

Inflammatory condition characterized by edema of supraglottic area, including epiglottis and pharyngeal structutes- mostly pediatric cases, bacterial, medical emergency

A

Epiglottitis

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40
Q

Abnormal collection of fluid in pleural cavity- occurs when rate of fluid formation exceeds rate of its removal

A

Pleural Effusion

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41
Q

Elevated LDH and protein in pleural fluid indicate what type of pleural effusion?

A

Exudative

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42
Q

incomplete expansion of the lung or portion of the lung due to compression or obstruction

A

Atelectasis

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43
Q

Two types of acute respiratory failure

A

Hypoxemia due to failure of gas exchange function and hypercapnia/hypoxemia due to ventilatory failure

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44
Q

ARF- areas of lung are ventilated but not perfused or when areas are perfused but not ventilated

A

Hypoxemia d/u failure of gas exchange- V/Q mismatching

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45
Q

ARF- impediment of gas exchange between alveolar air and pulmonary blood

A

Hypoxemia d/t failure of gas exchange- impaired diffusion

46
Q

ARF- unable to maintain level of alveolar ventilation sufficient to eliminate CO2 and keep O2 levels normal

A

Hypercapnia/Hypoxemic respiratory failure due to ventilatory failure

47
Q

Demyelination of white matter in brain, spinal cord and optic nerve

A

MS

48
Q

Controls impulses of emotion, hunger, sexual arousal, and aggression

A

Hippocampus

49
Q

Produces and responds to nonverbal signs of anger, avoidance, fear

A

Amygdala

50
Q

Regulation of body temp, endocrine, regulation of emotional expression

A

Hypothalamus

51
Q

Responsible for conscious and unconscious ability to maintain balance and posture

A

Cerebellum

52
Q

Has ipsilateral control of body

A

Cerebellum

53
Q

Has contralateral control of body

A

Cerebral cortex

54
Q

Important center for control of respiration

A

Pons

55
Q

Lowest portion of brain stem controlling autonomic nervous system- HR, RR, BP, cough, swallowing, vomiting

A

Medulla

56
Q

Chronic progressive disorder of basal ganglia leading to reduction of dopamine

A

Parkinson disease

57
Q

Neurogenerative disease characterized by senile plaques (accumulations of beta-amyloid protein) and neurofibrillary tangles (protein tau)

A

Alzheimer disease

58
Q

Causes cellular changes that result in brain atrophy due to loss of neurons in hippocampus and cortex

A

Alzheimer disease

59
Q

CVA that usually occurs with activity

A

Hemorrhagic CVA

60
Q

CVA that usually occurs at rest, most common cause of stroke from atherosclerotic blood vessels in brain

A

Thrombotic CVA

61
Q

CVA that causes aphasia or neglect and visual field abnormalities

A

Thrombotic CVA

62
Q

CVA that usually affects MCA with sudden onset of symptoms

A

Embolic CVA

63
Q

Small CVA infarcts that are located in deep non-cortical regions of the brain/brain stem that heal and form small cavities- can produce motor and sensory hemiplegia and clumsy hand syndrome

A

Lacunar infarcts

64
Q

Lacunar infarcts can be a result of _____ or ______.

A

Chronic hypertension or diabetes

65
Q

Bleeding of cerebral aneurysm that results in defective or injured vascular in subarachnoid space

A

Subarachnoid hemorrhage

66
Q

Failure to excrete bilirubin results in _____.

A

Jaundice

67
Q

Increased portal pressure and blood osmotic pressure results in _______.

A

Ascites

68
Q

Associated with flapping tremor

A

Hepatic encephalopathy

69
Q

Results from accumulation of toxins in the blood (mainly ammonia)- occurs as liver fails to transform or detoxify the blood because of poor hepatocyte function
o Causes osmotic pressure to increase, leading to brain swelling and cerebral edema
o Can lead to herniation and death

A

Hepatic Encephalopathy

70
Q

Normally converted to urea in liver and excreted by kidneys

A

Ammonia

71
Q

Transmitted by oral-fecal route, can be asymptomatic

A

Hepatitis A

72
Q

Most common cause of chronic liver disease, cirrhosis, liver cancer

A

Hepatitis C

73
Q

Transmitted through contact with infected blood, body fluids or contaminated needles or maternal transmission

A

Hepatitis B

74
Q

Causes induction of immune response against viral antigen

A

Hepatitis B

75
Q

Causes direct cellular injury

A

Hepatitis C

76
Q

4 stages of hepatitis

A

Incubation, prodromal, icteric, and recovery

77
Q

Occurs 2 weeks after exposure and ends with appearance of jaundice
 Fatigue, n/v, HA, low-grade fever
 RUQ pain, weight loss
 Infection is highly transmissible at this phase
 Serum ALT and AST start to show variable increases

A

Prodromal phase

78
Q

Lasts 2-6 weeks
 Jaundice is caused by hepatocellular destruction and intrahepatic bile stasis (less likely in HCV)
 Urine dark colored and stools clay colored from conjugated bili (before onset of jaundice)
 Actual phase of illness
 Liver is enlarged, smooth and tender- results in abdominal pain that persists or becomes more severe
 Jaundice lasts 2-6 weeks or longer- severe itching
 Prolonged prothrombin time

A

Icteric phase

79
Q

Chronic disease of liver characterized by the autoimmune destruction of intralobar bile ducts causing cholestasis

Clinical manifestations
 Insidious onset, progressive scarring, destruction of liver tissue
 Liver becomes enlarged and takes on a green huge from accumulated bile
 Pruritis, itching, weight loss, fatigue, dark urine, pale stools, osteoporosis, jaundice, serum alk phos elevated

A

Primary biliary cirrhosis

80
Q

Prolonged obstruction of extrabiliary tree

o Most commonly caused by cholelithiasis or malignant neoplasms of biliary tree or head of pancreas

A

Secondary biliary cirrhosis

81
Q

Produced in fetuses when developing in the womb. Drops down to essentially 0 by age 1. High levels may be a sign of liver cancer. Tumor marker. <10 ng/ml is normal. Above 500 ng/ml is a sign of liver cancer.

A

Alpha-fetoprotein

82
Q

Released during acute phase inflammatory response- liver increases synthesis- binds to surface of invading microorganisms and targets them for destruction by complement and phagocytosis

A

C-reactive protein

83
Q

Most dramatic rise is seen in cases of acute hepatocellular injury (not specific to liver)
o Viral hepatitis (rises in prodromal phase)
o Hypoxic or ischemic injury
o Acute toxic injury or Reye syndrome

A

AST

84
Q

Type of hormone: epinephrine, norepinephrine, thyroid, dopamine

A

Amines/amino acids

85
Q

Type of hormone: growth hormone, thyrotropin releasing hormone, insulin

A

Peptides/glycoproteins

86
Q

Type of hormone: derivatives of cholesterol, include the sex hormones like estrogen and testosterones

A

Steroids

87
Q

Type of hormone: arachidonic acid, leukotrienes, prostaglandins

A

Fatty acid derivatives

88
Q

Metabolizes and inactivates hormones, rendering hormones water soluble for renal excretion

A

Liver

89
Q

Regulated by hypothalamic broth-releasing hormone, has direct actions that stimulates growth of cartilage and insulin-like effects of promoting fuel storage in various tissues

A

Growth hormones

Ant. pituitary

90
Q

Produced upon stimulation of tRH from hypothalamus, travels to thyroid gland to stimulate synthesis of thyroid hormones (T4 and T3)

A

Thyrotropin (TSH)

Ant. pituitary

91
Q

Has the greatest metabolic effects

A

T3

92
Q

AKA tri-ido-thyronine

A

T3

93
Q

AKA thyroxine

A

T4

94
Q

T3 and T4 are made of…

A

Iodine

95
Q

One of the most common autoimmune diseases
o Unique antithyroid antibody that acts like a thyroid stimulating hormone
 Detectable in blood by lab test- thyroid-stimulation immunoglobulin (TSI)

A

Graves disease

96
Q

Two signs of Graves disease

A

Goiter and exophthalmos

97
Q

Nonbacterial inflammation of the thyroid
 Often preceded by viral infection
 Lasts 2-4 months
 Spontaneous recovery

A

Subacute primary hypothyroidism

98
Q

Most common cause of hypothyroidism (and goiter)
 Autoimmune disorder- thyroid may be totally destroyed by an autoimmune process
 Mostly seen in middle-aged women

A

Hashimoto primary hypothyroidism

99
Q

Indicative of severe or long-standing hypothyroidism
o Increased TSH, decreased free T4
o Cold intolerance, low energy, increased weight, edema
o Presence of non-pitting edema caused by increased mucopolysaccharide in connective tissues
o Face takes on a puffy look, especially around eyes
o Tongue becomes enlarged, voice hoarse and husky
o Mucopolysaccharide deposits can occur in heart causing cardiac dilation, bradycardia, pleural and pericardial effusion

A

Myxedema hypothyroidism

100
Q

Result of absent thyroid tissue or defects in thyroid synthesis
o Common cause of preventable mental retardation because thyroid hormone is important in mental development
o Can be identified within 1st week of life through state mandated infant metabolic screenings (IMS)
o Manifestations of untreated cases are known as cretinism
o If identified before 6 weeks old, can be reversed and results in normal intelligence

A

Congenital hypothyroidism

101
Q

Secreted in response to a rise in blood glucose- from where?

A

Insulin from beta cells

102
Q

Secreted when blood glucose levels are low- from where?

A

Glucagon from alpha cells

103
Q

Hypoglycemia occurs when BS is under

A

45 (but can be as high as 60 in some)

104
Q

Combo of nocturnal hypoglycemia followed by rebound hyperglycemia

A

Somogyi effect

105
Q

Relative deficiency of insulin and increase in insulin counterregulatory hormones like catecholamines, cortisol, glucagon, growth hormone
o Causing blood glucose levels to rise rapidly as a result of glucogenesis
o Polyuria and dehydration follow
- Hepatic glucose production increases, fat mobilization stimulated, ketone levels rise (ketosis) as a result of the nearly total use of fatty acids to produce ATP

A

Ketoacidosis

106
Q

DKA occurs in which DM?

A

DM I

107
Q

Caused by chronic hypoxia of nerve cells by effects of hyperglycemia

A

Diabetic neuropathy

108
Q

Caused by microvascular disease due to changes in small blood vessels called hyaline arteriosclerosis

A

Diabetic retinopathy and nephropathy

109
Q

Sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face.
Abnormal writhing movements

A

Chorea

110
Q

Most disabling symptom of PD

Slowness in initiating and performing movements and difficulty with sudden, unexpected stopping of voluntary movements.

A

Bradykinesia

Advanced Pathophysiology (4 decks)

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