PATHOPHYS (SG Alterations of Pulmonary Function)

How does a large pulmonary embolism cause V/Q mismatch?

76. Although ventilation (V) continues with a pulmonary embolism, the pulmonary embolus stops perfusion (Q) in pulmonary blood vessels, creating ventilation-perfusion (V/Q) mismatch.

Genetic deficiency of ______ causes early-onset emphysema because this enzyme normally inhibits the action of _________ that can destroy lung tissue

Alpha 1-antitrypsin; proteolytic enzymes

Collapse of alveoli

Atelectasis

Mrs. Yarborough, age 47, who smokes a pack of cigarettes per day, develops fever, chills, dyspnea, and a cough productive of yellow-green sputum. Her body temperature is 38.5 0C (101.30 F). She has tachypnea, tachycardia, and inspiratory crackles auscultated over her right upper and lower lung. Sputum stain reveals numerous white blood cells and bacteria. What is her dx?

Bacterial pneumonia

Alternating periods of deep and shallow breathing with apnea episodes is called

Cheyne-stokes

The two disorders known as COPD are emphysema and ______

Chronic Bronchitis

Bluish discoloration of the skin caused by desaturation of hemoglobin Pa02 below normal

Cyanosis

Mrs. Beeson's radiograph shows a dense white collection of fluid at the base of the left lung, where it obscures the left diaphragm and much of the lower left lung. Thoracentesis reveals numerous white blood cells and bacteria in her pleural fluid. Mrs. Beeson's diagnosis is

Empyema

Rhythmic and effortless with normal tidal volume is called

Eupnea

People who have obstructive respiratory disorders have the most difficulty with (inspiration, expiration).

Expiration

What happens when antigen binds to the IgE located on the mast cells? Why is that important?

The mast cell degranulates when antigen binds to the IgE located on the mast cell membrane. Mast cell degranulation releases inflammatory mediators that cause inflammation, bronchoconstriction, and increased secretion of mucus.

Why does Mrs. Beeson experience dyspnea?

accumulated empyema fluid is compressing her left lung or at least preventing it from expanding, which interferes with ventilation and gas exchange.

What is a tubercle?

accumulation of white blood cells, mostly derived from neutrophils, macrophages, and lymphocytes, around a foreign body or microorganisms that phagocytes are unable to remove effectively

Mrs. Goh, age 46, emigrated from Southeast Asia 25 years ago. She is admitted to the hospital with low-grade fever, shortness of breath, and a cough producing discolored sputum. Further evaluation reveals that she has had an unintentional weight loss of 15 pounds in the past 4 months. Examination of her sputum is positive for Mycobacterium tuberculosis. Her diagnosis is

active tuberculosis (TB) disease.

A person who has a pneumothorax has _____in the pleural space.

air

What is compression atelectasis

alveolar collapse caused by external pressure on the alveoli

What is absorption atelectasis

alveolar collapse caused by gases being absorbed from alveoli that are obstructed

Where does empyema fluid usually originate?

as leakage of lymphatic drainage from sites of bacterial pneumonia

Passage of fluid and/or solid particles into the lungs is called

aspiration

Clinical manifestations of emphysema include _____chest and _____ on exertion and eventually at rest

barrel; dyspnea

A person who has _______ has persistent abnormal dilations of the bronchi and a chronic cough that produces large amounts of purulent _____

bronchiectasis; sputum

The acute effect of marijuana on bronchial smooth muscle is (bronchoconstriction, bronchodilation).

bronchodilation

Primary lung cancer arising from cells that line the airways is called _______ _______

bronchogenic carcinoma

Clubbing of the fingers is a response to (acute, chronic) hypoxemia.

chronic

The most common cause of lung cancer is (poor nutrition, cigarette smoking);

cigarette smoking

What is the pathophysiology of Mrs. Yarborough's illness of Bacterial pneumonia

cigarette smoking compromises the upper airway defenses. Bacteria reach the lung, causing inflammation. Bacteria; white blood cells, cytokines, and exudate flood the alveoli, causing V/Q mismatching that leads to hypoxemia

Pulmonary fibrosis is an excessive amount of _______ tissue in the lungs and causes _______ lung compliance.

connective (or fibrotic); decreased

Severe kyphoscoliosis causes (increased, decreased) chest wall compliance.

decreased

A person who has pulmonary edema will have (resonance, dullness) to percussion over the lung bases, inspiratory (wheezing, crackles), and with severe pulmonary edema, (foul-smelling, pink frothy) sputum.

dullness; crackles; pink and frothy

Presence of fluid in the pleural space is called pleural (edema, effusion).

effusion

Presence of pus in the pleural cavity is called

empyema

Processes that increase capillary permeability can cause (exudative, transudative) pleural effusion

exudative

What is dyspnea

feeling of breathlessness

What is orthopnea

feeling of breathlessness when lying flat

Coughing up bloody mucus is called

hemoptysis

What is stridor

high-pitched sounds made during inspiration

Laryngeal cancer is characterized by progressive ______

hoarseness

Small cell carcinoma in the lung often produces tumor-derived ______

hormones

Anxiety (hypoventilation or hyperventilation)

hyperventilation

Response to severe hypoxemia (hypoventilation or hyperventilation)

hyperventilation

Airway obstruction (hypoventilation or hyperventilation)

hypoventilation

Reduced compliance of chest wall (hypoventilation or hyperventilation)

hypoventilation

Reduced firing of neurons to respiratory muscles (hypoventilation or hyperventilation)

hypoventilation

Respiratory muscle weakness (hypoventilation or hyperventilation)

hypoventilation

PaO2 below normal

hypoxemia

Rib fractures that disrupt the mechanics of breathing can cause a portion of the chest wall to collapse ____ during inspiration, an acute condition known as _________ chest.

inward; flail

What is wheezing

is whistling sounds on expiration

During an acute asthma episode, inflammatory mediators cause inflammation, hypersecretion of _______ and bronchial smooth muscle ____

mucus; constriction

COPD is characterized by persistent hypersecretion of _______ and chronic _______ cough.

mucus; productive

Clinical manifestations of bronchiolitis include tachypnea, (productive, nonproductive) cough, use of accessory muscles, (low-grade, high) fever, and hypoxemia.

nonproductive; low-grade

Asthma is a(n) (obstructive, restrictive) respiratory disease.

obstructive

Waking up suddenly with dyspnea during the night and needing to sit upright or stand to breathe is called

paroxysmal nocturnal dyspnea

What is Empyema?

pus (white blood cells and bacteria) in the pleural space.

In asthma, long-term airway damage that is irreversible is known airway _____

remodeling

Silicosis is a(n) (obstructive, restrictive) respiratory disease

restrictive

Cor pulmonale is ______ ventricular enlargement caused by chronic pulmonary ______

right; hypertension

An asthma episode that does not resolve with usual treatment is called ____

status asthmaticus

Persons who have difficulty (coughing, swallowing) have increased risk for aspiration; aspiration of gastric acid is most likely to cause (bronchiolitis, pneumonitis).

swallowing; pneumonitis

What is tension pneumothorax

the pressure of the air in the pleural space exceeds barometric pressure because air enters during inspiration but cannot exit during expiration

What is communicating pneumothorax

the pressure of the air in the pleural space is the same as barometric pressure because the air drawn into the pleural space during inspiration is forced back out during expiration

How is tuberculosis transmitted?

through the air, contained in droplets

Processes that increase capillary hydrostatic pressure can cause (exudative, transudative) pleural effusion.

transudative

Early lung cancer has (vague, obvious) signs and symptoms.

vague

When the TB bacilli were sequestered in the tubercle, did the pt have a positive tuberculin skin test?

yes

Irregular, quick inspirations with an expiratory pause is called

Gasping

Head injury (hypoventilation or hyperventilation)

Hyperventilation

Increased ventilatory rate, very large tidal volume, no expiratory pause is called

Kussmaul

Increased ventilatory rate, small tidal volume, increased effort, prolonged restricted expiration, wheezing is called

Obstruction breathing

Hyperventilation causes decreased (Paco2, Pao2).

Paco2

What will clear the consolidated exudate from a pts alveoli as they recover from bacterial pneumonia?

Phagocytic cells, such as macrophages, will clear much of the consolidated exudate

Increased ventilatory rate, small tidal volume is called

Restricted breathing

Why is smoking cessation important for a pt to help prevent another episode of pneumonia?

Smoking paralyzes the cilia, can cause squamous metaplasia, can trigger chronic inflammation in the bronchi, and increases the production of mucus. These effects of smoking all compromise the upper airway defenses, making them more vulnerable to pneumonia

Which end of IgE binds to receptors in the mast cell plasma membrane?

The Fc (constant fragment) end of IgE binds to Fc receptors in the mast cell plasma membrane

What is the source of the IgE that binds to mast cells?

The IgE is produced by plasma cells (mature B lymphocytes) that have become committed to a specific antigen.