Pulmonary Pathology Exam 1

hypoxemia

defined as deficient oxygenation of arterial blood; decreased arterial PO₂

arterial PO2

What blood gas value is decreased in hypoxemia?

blood (arterial oxygen levels)

Does hypoxemia refer to blood or tissues?

high altitude

Name a major environmental cause of hypoxemia

reduced alveolar oxygen leads to decreased PaO2

How does hypoventilation cause hypoxemia?

diffusion defect

What type of defect involves impaired gas transfer across the alveolar membrane?

Blood bypasses ventilated alveoli and is not oxygenated

How do right-to-left shunts cause hypoxemia?

Diffusion defects, V/Q mismatch, or shunt

hypoxemia

What does an increased (widened) A–a gradient indicate?

hypoxia

defined as decreased oxygen delivery to or utilization by tissues

Yes (e.g., anemia, CO poisoning)

Can hypoxia occur without hypoxemia?

reduced blood flow lowers oxygen delivery to tissues

How does decreased cardiac output cause hypoxia?

Decreased hemoglobin reduces oxygen-carrying capacity.

Why does anemia cause hypoxia?

Binds hemoglobin, preventing oxygen transport

How does carbon monoxide cause hypoxia?

Blocks cellular oxygen utilization (histotoxic hypoxia)

How does cyanide cause hypoxia?

Hypoxemia = low blood O₂

Hypoxia = low tissue O₂ delivery/use

Difference between hypoxemia and hypoxia?

decreased (<0.8)

What happens to FEV₁/FVC in obstructive disease?

normal or increased

What happens to FEV₁/FVC in restrictive disease?

increased (trapped air)

Lung volumes in obstructive disease?

decreased

Lung volumes in restrictive disease?

difficulty getting air out

Primary problem in obstructive lung disease?

difficulty getting air in

Primary problem in restrictive lung disease?

restrictive lung disease

Which type is often associated with poor diffusion?

Air trapping due to airway collapse/obstruction

Why are volumes elevated in obstructive disease?

smoking

primary cause of COPD

Exposure to noxious environmental particles and genetics

Other causes of COPD besides smoking?

Abnormal chronic inflammation causing structural airway and vascular changes

What is the main pathologic process in COPD?

It is reduced, causing gas trapping

What happens to expiratory flow in COPD?

Air trapping leads to static and dynamic hyperinflation of lungs

What is hyperinflation in COPD?

Decreases inhalation volume and respiratory function

How does hyperinflation affect breathing?

Around 55-60 years old

Typical age of COPD onset?

Airway obstruction, air trapping, gas exchange abnormalities, mucus secretion

Key physiologic abnormalities seen in COPD?

Pulmonary hypertension

Vascular complication of COPD?

Exercise intolerance

Functional limitation common in COPD?

Weight loss, muscle wasting, fatigue (systemic features)

Systemic effects seen in COPD?

Productive cough ≥3 months/year for 2 consecutive years

Diagnostic criteria for chronic bronchitis?

Productive cough

Main symptom of chronic bronchitis?

Cyanosis

Skin color commonly seen in chronic bronchitis?

Cor pulmonale (right-sided heart failure)

Why does peripheral edema occur in chronic bronchitis?

Crackles and wheezes

Lung sounds in chronic bronchitis?

Enlargement of air spaces with loss of elasticity

Pathologic hallmark of emphysema?

Loss of elastic recoil

What causes airway collapse in emphysema?

Dyspnea

Primary symptom of emphysema?

Tachypnea

Breathing pattern seen in emphysema?

Cachexia (thin, wasted appearance)

Body habitus associated with emphysema?

minimal cough

Cough severity in emphysema?

anxiety

Psychological symptom common in emphysema?

Chronic bronchitis

Which COPD type is the "blue bloater"?

Hypoxemia from mucus and airway obstruction

Why are "blue bloaters" cyanotic?

Cor pulmonale leading to fluid retention

Why do blue bloaters have edema?

Morning and evening

When is cough worst in blue bloaters?

Emphysema

Which COPD type is the "pink puffer"?

Adequate oxygenation due to hyperventilation

Why are pink puffers not cyanotic initially?

Difficulty exhaling due to loss of airway elasticity

Main breathing problem in pink puffers?

acute bronchitis

Short-term inflammation of the trachea and bronchi (tracheobronchial tree), lasting ~2–5 weeks

viral infection or chemical irritation

usual cause of acute bronchitis

With symptoms of an upper respiratory infection (common cold)

How does acute bronchitis typically begin?

Dry, irritating cough due to transient airway hyperresponsiveness

What type of cough occurs early in acute bronchitis?

Becomes productive with purulent sputum and wheezing

How does the cough change as acute bronchitis progresses?

Fever, sore throat, nasal congestion, chest pain from coughing, possible laryngitis

What are common associated symptoms of acute bronchitis?

Cold, dry, or dusty air

What worsens viral bronchitis cough?

Usually nonproductive initially

Is viral bronchitis usually productive or nonproductive?

Conservative: rest, humidity, nutrition, and hydration

What is the main treatment approach for acute bronchitis?

asthma

Inflammation and increased reactivity of airway smooth muscle causing bronchoconstriction and airflow resistance

yes

is asthma reversible

Inflammatory mediators released due to airway inflammation

What triggers bronchospasm in asthma?

Large families, early pet exposure, early infections, older siblings, daycare attendance

What factors are protective against asthma development?

Vigorous activity triggering bronchoconstriction

What causes exercise-induced asthma symptoms?

Within 5-15 minutes after vigorous activity

When do exercise-induced asthma symptoms usually occur?

Bronchospasm, vascular congestion, increased permeability, edema, mucus production, impaired mucociliary function

What physiologic changes occur in asthma inflammation

Genetics, environmental exposure, childhood respiratory infections, low birth weight, low socioeconomic status

What are major risk factors for asthma

Nonproductive cough

What type of cough is typical in asthma?

Shortness of breath and wheezing

Key respiratory symptoms of asthma?

Due to air hunger and hypoxia

Why do asthma patients feel anxious during attacks?

Sitting forward using arms to assist breathing

What is the tripod position?

Hypoxia, tachycardia, cyanosis

What are signs of severe asthma exacerbation?

bronchiectasis

Progressive condition with irreversible destruction and dilation of the airways, specifically the bronchi and bronchioles

bilateral lower lung lobes

what does bronchiectasis primarily impact

chronic inflammation that occurs after a pulmonary infection

etiology of bronchiectasis

Chronic infection and chronic inflammation of the airways

What is the primary underlying problem in bronchiectasis?

Impaired defense against microorganisms and reduced mucociliary function

How is mucociliary clearance affected in bronchiectasis

Permanent dilation of the airways

What structural change occurs in the airways in bronchiectasis?

Chronic inflammatory changes with secondary infection weaken supporting structures

Why do bronchial walls become weakened in bronchiectasis?

They are destroyed, making the walls flabby and scarred

What happens to the muscular and elastic components of bronchial walls?

Enzymatic degradation from chronic inflammation and infection

What causes destruction of airway connective tissue in bronchiectasis

Chronic productive cough, frequent respiratory infections, and ongoing inflammation

What symptoms result from airway destruction in bronchiectasis

Persistent cough with large amounts of purulent sputum

Most common cough characteristic in bronchiectasis

the morning

When is sputum production often worse in bronchiectasis

Dyspnea (shortness of breath)

Common breathing symptom in bronchiectasis

Rhinosinusitis

Upper airway condition commonly associated with bronchiectasis

Fatigue, weight loss, exercise intolerance

Systemic symptoms seen in bronchiectasis

Due to damaged, inflamed bronchial blood vessels

Why does hemoptysis occur in bronchiectasis

Pneumonia

Common infectious complication of bronchiectasis

Chronic hypoxia and pulmonary hypertension

What chronic complication leads to finger clubbing in bronchiectasis

cystic fibrosis

Inherited disorder of chloride ion transport in exocrine glands

Respiratory, digestive, hepatic, and reproductive systems

Which body systems are affected by cystic fibrosis?

genetic mutation of the CFTR gene

Cause of cystic fibrosis

chromosome 7

On which chromosome is the CFTR gene located

Inability to properly transport chloride across cell membranes.

Primary cellular defect in cystic fibrosis?

Lungs, pancreas, intestines, and sweat glands.

Which organs are especially affected by thick mucus in CF?

Chloride cannot be reabsorbed properly in sweat glands.

Why are sweat electrolytes increased in CF patients?