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Patho > Week 8: Respiratory > Flashcards

Week 8: Respiratory Flashcards

1
Q

What respiratory structures make up the respiratory zone?

A

respiratory bronchioles, alveolar ducts, alveoli

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2
Q

What is another name for the respiratory zone?

A

lung parenchyma

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3
Q

What is the major role of the respiratory zone?

A

responsible for gas exchange

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4
Q

What do each variable of Fick’s Law of Diffusion represent?

A

D: Partial pressures and gas solubilities
A: surface area of the respiratory membrane
C: concentration gradient
X: Thickness of the respiratory membrane

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5
Q

What are examples of diseases that affect the variables of Fick’s law of diffusion?

A

X: Pulmonary fibrosis
A: Emphysema or atelectasis
DC: High altitude - decreased concentrations of O2 in inspired air

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6
Q

Where is the respiratory regulatory center located and what are the two organs involved?

A

Regulatory center located in the brainstem

Medulla sets the rhythm, pons modifies the rhythm

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7
Q

What is the primary and secondary signal for respiratory regulation?

A

Primary: CO2
Secondary: O2

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8
Q

Define the following breathing patterns: eupnea, tachypnea, dyspnea, apnea

A

Eupnea: normal quiet breathing
Tachypnea: increased respiratory rate
Dyspnea: subjective sensation of breathlessness
Apnea: cessation of respiration

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9
Q

What are Cheyne-Stokes respirations? What is it a sign of and when is it often seen?

A

waxing and waning tidal volume with periodic apnea sign of impending death, seen in heart failure and stroke

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10
Q

What are Kusmaal respirations and when does it occur?

A

rapid and deep ventilation - when body becomes acidic, respiratory compensation, example DKA

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11
Q

Define and explain the importance of pulmonary function testing and arterial blood gas evaluation with regard to pulmonary assessment.

A

PFT: tests elastic properties of the lung & airway resistance
ABG: assess pulmonary gas exchange and delivery to tissues

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12
Q

Define ventilation and perfusion

A

Ventilation: flow of gases into and out of the alveoli of the lungs
Perfusion: flow of blood in the adjacent pulmonary capillaries

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13
Q

How is ventilation and perfusion normally matched?

A

Normally matches cardiac output - 5-6 liters

Normal ratio: 0.6-3.0

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14
Q

What is the consequence of V/Q mismatching on gas exchange? What are the s/s (3)?

A

This will cause a change in the V/Q ratio and can affect the efficiency of gas exchange
Increasing inspired O2 fraction will improve hypoxia due to an inequality in V/Q but the greater the inequality the less the response to increasing FIO2
S/S: dyspnea, cyanosis and clubbing

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15
Q

Define hypoxemia and what is the common cause

A

Hypoxemia = PaO2 < 85mmHg

Common cause: mismatched ventilation and perfusion

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16
Q

What are causes of mismatched ventilation and perfusion (4)?

A
  1. Decreased O2 in inspired air: high altitude or anesthesia mismanagement
  2. Alveolar hypoventilation: pulmonary or neuromuscular disease, CNS depression, inadequate ventilation during anesthesia
  3. Diffusion abnormalities: pulmonary edema, fibrosis
  4. Issues with circulation: right to left shunt, congenital heart defect, atelectasis
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17
Q

Define hypercapnia and what is the common cause

A

Hypercapnia = increased PaCO2 (normal 38-42)

Common cause: hypoventilation

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18
Q

What are the causes of hypoventilation (5)?

A
  1. Depression of resp center
  2. Diseases of medulla (infections of CNS or trauma)
  3. Spinal cord disruption
  4. Diseases of the neuromuscular junction
  5. Large airway obstruction
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19
Q

Define dead space, what disorders can increase dead space?

A

Dead space: ventilation without perfusion due to occlusion of blood supply
Pulmonary embolism, emphysema

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20
Q

Define shunt and identify three causes of shunt

A

Shunt: no ventilation with perfusion; - no gas exchange occurs in that alveoli and increases shunt fraction
obstructed airway, bronchoconstriction, pulmonary edema

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21
Q

Define compliance

A

Compliance = measure of lung and chest wall dispensability, defined as volume change per unit of pressure change

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22
Q

How do elastin and collagen contribute to compliance?

A

Elastin: stretchy connective tissue fiber within alveolar walls that contributes to passive deflation of the lungs
Collagen: resistance to stretchability (opposes surface tension)

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23
Q

Define surface tension

A

Refers to tendency for liquid molecules exposed to air to adhere to one another

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24
Q

What is surfactant?

A

Surfactant: detergent-like substance that helps keep air stretches open, reduces air patches of liquid on sides of wall

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25
Q

What happens in a disorder of increased compliance, and what is an example?

A

Disorder of increased compliance: over stretched, recoil is affected
Emphysema - loss of elastic tissue

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26
Q

What happens in a disorder of decreased compliance, and what are two examples?

A

Disorder of decreased compliance: lungs become stiff

pulmonary fibrosis - increased collagen which enhances stiffness
pulmonary edema - increased interstitial fluid

27
Q

Define pneumothorax

A

Pneumothorax = accumulation of air in the pleural space that can result in partial or complete collapse

28
Q

Distinguish between spontaneous, secondary, tension pneumothorax

A

Spontaneous (closed): air-filled blebs/blisters on lung surface form and rupture, allowing air from the inside of the lungs to enter the pleural space; commonly occurs in male smokers

Secondary: air enters pleural space as a result of chest wall injury or punctures

Tension: air enters but does not leave pleural space

29
Q

Define pleural effusion

A

Pleural effusion = abnormal collection of fluid in pleural cavity

30
Q

Define hydrothorax, when is it seen and what is the possible cause?

A

Hydrothorax - transudate (filtrate of blood)
Seen in CHF, renal failure, nephrosis, liver failure
Poss cause: loss of albumin, changes osmotic pressure and leads to collection of fluids

31
Q

Define empyema, when is it seen (4)?

A

○ Empyema - exudate that comes from inflammatory process or immune response
Seen in infections, malignancies, RA, lupus

32
Q

Define hemothorax, when is it seen?

A

Hemothorax - blood

Seen in chest injury, surgery, malignancies, vessel rupture

33
Q

Define chylothorax, what is the cause and when is it seen?

A

Chylothorax - chyle (lymph)
Caused by obstructed lymph return to blood
Seen in trauma, infection, malignant infiltration

34
Q

Define atelectasis, what are causes of primary vs. secondary (3)?

A

Atelectasis = collapse of previously expanded lung tissue (secondary) or incomplete expansion of lungs at birth (primary)

Primary - typically due to insufficient surfactant

Secondary - typically due to airway obstruction, lung compression (pneumothorax or pleural effusion), increased lung recoil (decreased surfactant)

35
Q

How does surgery increase the risk for atelectasis?

A

Anesthesia - nitrogen wash out
Narcotics
Immobility

36
Q

Explain how decreased surfactant; ineffective cough reflex; and increased sputum viscosity contribute to atelectasis.

A

decreased surfactant: increased recoil

Ineffective cough reflex: poor alveolar expansion and obstruction

Increased sputum viscosity: airway obstruction

37
Q

Define airway resistance; explain what law explains resistance; and, identify the one parameter that is most important for defining resistance to airflow

A

Airway resistance: resistance to airflow, defined by differences between atmospheric pressure and alveolar pressure relative to resistance
Law: Pouiseuille’s law
Parameter: radius of the airway

38
Q

Fill in the blanks: The _____ the radius the _____ the resistance

A
  1. smaller

2. larger

39
Q

Define obstructive disorder, identify the best indicator of obstructive lung disorder

A

Obstructive disorder: obstruct the ability of air to flow into the lungs, characterized by increased airway resistance
Best indicated by FEV1/FVC ratio (reduced)

40
Q

Define chronic bronchitis

A

inflammation, mucus secretion, obstruction of airway

41
Q

Define bronchiestasis

A

persistent abnormal dilation of the bronchi that is frequently associated with bronchitis

42
Q

Define bronchiolitis

A

inflammatory obstruction of the bronchioles

43
Q

Define asthma

A

hypersensitivity, increased mucus production, bronchoconstriction

44
Q

Define emphysema

A

enzyme digestion of proteins like elastin leading to increased compliance; abnormal permanent enlargement of gas exchange airways accompanied by destruction of alveolar walls

45
Q

Distinguish between primary vs. secondary emphysema. What is the prevalence of each?

A

□ Primary emphysema: results from inherited deficiency of an alpha-1 antitrypsin that inhibits the action of proteolytic enzymes which chew elastin (1-2% of cases)

Secondary: caused by inability of body to inhibit proteolytic enzymes (common), due to toxins, smoking

46
Q

Define restrictive disorder, identify the best indicator, and what would a PFT look like?

A

characterized by lungs that are difficult to inflate
Decreased compliance = best indicator

PFT: Tidal volume and vital capacity correspondingly decreased
Decreased FEV1 and FVC, but ratio may be normal or increased

47
Q

Define pulmonary fibrosis

A

Excess CT, elastin

48
Q

What are causes of pulmonary fibrosis (5)?

A

secondary to other diseases involving autoimmunity, infection or injury or idiopathic, environmental pollutants (asbestos, cigarettes)

49
Q

S/S of pulmonary fibrosis (7)

A

SOB (progressive), cough, fatigue, weakness, chest discomfort, loss of appetite, rapid weight loss

50
Q

Consequences of pulmonary fibrosis (3)

A
  • Exchange of parenchymal tissue with fibrotic tissue
  • Increased thickness of resp membrane and reduced efficiency of gas exchange
  • Overall ability to provide O2 to blood is compromised
51
Q

Define pulmonary edema

A

Excess fluid in extravascular spaces of the lungs that restricts expansion

52
Q

What is pulmonary edema a common complication of?

A

cardiac disorders, chronic or acute

53
Q

What are risk factors for pulmonary edema (3)?

A

heart disease, ARDS, inhalation of toxic gases

54
Q

Define pneumonia

A

infection of lower respiratory tract by microorganisms

55
Q

Define pulmonary embolism, what are the typical causes (4)

A

Pulmonary embolism: occlusion of portion of vascular bed by embolus

Causes: Thrombus, tissue fragment, lipids, air bubble

56
Q

Major consequence of pulmonary embolism

A

backflow of blood to R ventricle and increased HTN, increased jugular venous pressure, fluid imbalances, decreased gas exchange (hypoxemia)

57
Q

Sx of pulmonary embolism (2) What impacts the degree of symptoms?

A

dyspnea, tachypnea with severe chest pain,

size impacts the degree of symptoms

58
Q

Define pulmonary hypertension

A

HTN in pulmonary arteries, secondary to increased volume or pressure of blood or narrowing/obstruction of vessels

59
Q

Define cor pulmonale

A

right ventricular enlargement secondary to pulmonary HTN caused by disorders of lungs or chest wall

60
Q

Define acute respiratory failure, causes

A

inadequate gas exchange

Causes: direct injury to lungs, airways, chest wall, or indirectly to brain

61
Q

Define acute respiratory distress syndrome (ARDS)

A

fulminate form of respiratory failure characterized by acute lung inflammation, diffuse alveolocapillary injury

62
Q

What are risks for developing acute respiratory distress syndrome (ARDS)? (6)

A

Pneumonia, near drowning, toxins, DIC, infection, trauma

63
Q

Lung cancers arise from the _________ of the __________ and are most commonly caused by _______

A
  1. epithelium
  2. respiratory tract
  3. cigarette smoking
64
Q

Distinguish between small cell and non-small cell lung cancer

A

Small cell: rapid growing with early and widespread metastasis (25% of cases)
Non-small cell (adenocarcinoma, squamous cell, large cell): slower growing, does not typically metastasize (75% of cases)

Patho (14 decks)

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