Pulmonary Disorders

exam 2

What is dyspnea?

difficulty or labored breathing; SOB

What is apnea?

temporary absence of breathing

what is tachypnea?

abnormally fast breathing rate

What is hypoxemia?

low oxygen levels in the blood 

What is hypercapnia?

high carbon dioxide levels in the blood 

what is cyanosis?

bluish discoloration of skin or lips fue to low oxygen

what is hemoptysis?

coughing up blood from the lungs or airways

What is pleural effusion?

fluid buildup between the lung and chest wall

what is pneumothorax?

air in the pleural space causing lung collapse

what is a pulmonary edema?

fluid in the lungs, often from heart failure

what is atelectasis?

collapse or incomplete expansion of part of the lung

What is ventilation?

the movement of air in and out of the lungs - bringing oxygen in and removing carbon dioxide

what system control ventilation?

the respiratory system- mainly th lungs and airways 

What is perfusion?

The flow of blood through the lungs so gases can be exchanged between the air and the blood

What system controls perfusion?

The cardiovascular system - mainly the heart and pulmonary circulation

How do ventilation and perfusion work together?

Air brings oxygen to the lungs (ventilation) and blood carries it to the body (perfusion); they must stay balanced for good gas exchange 

What is surfactant?

A slippery, fatty substance made by the alveoli that reduces tension in the lungs

What does surfactant do?

It keeps alveoli from collapsing when you breathe out and helps them stay open for easier gas exchange 

Why is surfactant important?

Without it, the alveoli would stick together, making it hard to breathe and exchange oxygen and caarbon dioxide

What is Tidal Volume (TV)?

the amount of air inhaled or exhaled in a normal breath

What is inspiratory reserve volume (IRV)?

The extra air you can breathe in after a normal inhale

What is Expiratory Reserve volume (ERV)?

The extra air that you can breathe out after a normal exhale?

What is residual volume (RV)?

The air left in the lungs adter you fully exhale - it keeps the lungs from collapsing

What is vital capacity (VC)?

The total amount of air you can exhale after taking the deepest breath possible (TV+IRV+ERV) 

What is total lung capacity?

The total amount of air your lungs can hold (VC+RV)

What is Inspiratory Capacity (IC)?

The total amount of air you can breathe in after a normal exhale

What is a Functional Residual Capacity (FRC)? 

The air left in your lungs adter a normal exhale (ERV + RV) 

Why must ventilation and perfusion be matched?

because oxygen needs to reach areas of the lungs that have blood flow for gas exchange to happen —> if unmatched poor oxygenation 

What is dead air space?

when air gets into the lungs and doesn’t reach blood flow - so no gas exchange happens 

What is a shunt?

When blood passes through the lungs but doesn’t get oxygen because air can’t reach that area.  ex. pneumonia or collapsed alveoli 

What are the 2 types of V/Q mismatch?

Low V/Q (shunt-like) and high V/Q (dead-space-like)

What is low V/Q mismatch?

not enough ventilation —> poor oxygenation (ex. mucus, blockage, pneumonia)

What is high V/Q mismatch?

not enough perfusion —> wasted air (ex. pulmonary embolism)

What is pneumonia?

Inflammation of the alveoli, bronchioles, and / or interstitum caused by infection or irritants.

What are common causes of pneumonia?

Infectious: bacteria, viruses, and mycoplasma
Non-infectious: aspiration (stomach contents), inhaled fumes or particles 

What is typical pneumonia?

caused by bacteria

multiple alveoli —> inflammation + fluid buildup 

more severe bc it causes V/Q mismatch 

What is atypical pneumonia?

caused by viruses or mycoplasma

affects alveolar septum and interstitium

milder form —→ walking pneumonia 

What is community-acquired pneumonia?

infection from outside the hisptal

diagnosed < 48 hrs of admission

van be bacterial or viral 

common cause: Streptococcus pneumoniae (gram +) 

What is hospital-acquired pneumonia?

develops >48 hrs in hospital 

often bacterial and antibiotic-resistant 

common causes: pseudomonas aeruginosa, Staphylococcus aureus, E. coli

Includes ventilator-associated pneumonia

Where does hospital pneumonia usually occur?

in the lower respiratory tract, especially in pts on ventilators or with weakened defenses

why is hospital pneumonia usually harder to treat?

many hospital bacteria are antibiotic-resistan, making it more difficult

Are atypical pneumonias usually community ot hospital acquired?

community-acquired, often caused by viruses or mycoplasma 

What bacterium causes tuberculosis?

mycobacterium tuberculosis

How is TB primarily transmitted?

through airborne droplets when an infected person coughs, sneezes, talks, sings or laughs

What is the Mantoux skin test used for?

to screen for TB infection

How is the test administered and read as a positive result?

by injecting a small amount of purified protein derivative tuberculin under the skin of the forearm. And if a raised bump is at the injection site and measureed 48-72 hours after administration 

What are common symptoms of active TB?

persistant cough, chest pain, coughing up blood, fatiuge, wt loss, fever, night sweats

What happens if TB is left untreated?

it can lead to severe complications and can be fatal

What is an obstructive pulmonary disorder?

A lung problem where air has trouble leaving the lungs due to narrowed or blocked airways 

What is a restrictive pulmonary disorder?

A lung problem where lungs can’t fully expand —> less air gets in

What is the main difference bwtween obstructive and restrictive pulmonary disorders?

Obstructive - trouble exhaling —> air gets trapped

restrictive - trouble inhaling —> lungs can’t expand fully

Examples of obstructive pulmonary disorders

asthma, COPD, chronic bronchitis, emphysema

examples of restrictive pulmonary disorders

pulmonary fibrosis, scoliosis, nueormuscular disease

How does hypoxia increase red blood cells?

low oxygen → kidneys release EPO → bone marroe makes more RBCs → increased oxygen delivery

What are the 2 major subtypes of obstructive airway disorders?

Asthma and COPD

How is asthma characterized?

reversible airway obstruction, inflammation and bronchial hyperactivity

How is COPD characterized?

progressive, irreversible airway obstruction, usually caused by chronic bronchitis or emphysema 

What are the 2 main types of COPD?

Emphysema and chronic bronchitis 

How is emphysema classified?

damage to alveoli → enlarged air spaces → loss of elastic recoil → difficulty exhaling

How is chronic bronschitis classified?

chronic inflammation to bronchi → excessibe mucus profuction → persistent cough and airway obstruction

What role do mast cells play in asthma?

release histamine and leukotrienes -→ cause bronchoconstriction and inflammation 

What is the role of IgE in asthma?

binds allergens → triggers mast cell activation → starts the allergic response

What do histamine and leukptrienes do in asthma?

cause bronchoconstriction, mucus secretion, and airway inflammation

How does mucus contribute to asthma?

blocks airways → makes breathing difficult

How does parasympathetic stimulation affect asthma?

causes bronchocontriction and increased mucus secretion

how does inflammation contribute to asthma?

neutrophils, mast cells, and cytokines → damage airway lining and worsen obstruction

What is the effect of bronchial wall edema in asthma?

swelling narrows airways so it reduces blood flow. 

What is airway remodeling in asthma?

long term changed - thickened airway walls, more smooth muscle, and fibrosis -→ chronic airflow limitation 

Why is prevention of acute asthma attacks important?

to avoid severe airway constriction, hypoxia, and permanent airway damage from repeated attacks

What are common triggers of asthma?

allergens, pollutant, upper respiratory infection, exercise, cold air, GERD, aspirin, NSAIDs

What happens to FEV1 in asthma?

it decreases during an asthma attack due to airway obstruction 

What happens to FEV1/FVC ratio in asthma?

descreases during obstruction 

Can FEV1 and FEV1/FVC return to normal in asthma?

yes - asthma is reversible, so these values often improve after bronchodilator treatment

What triggers chronic bronchitis? 

chronic irritation of the airways leading to inflammation 

How does chronic irritation affect the airways?

causes hypersecretion of mucus, thick mucus blocks airways

How does the effect of mucus blockage on ventilation?

leads to V/Q mismatch -→ some areas get blood but not enough air

what are the consequences of V/Q mismatch in bronchitis?

hypoxia, cyanosis, and dyspnea

Why do patients with chronic bronchitis often appear blue?

because low oxygen levels persist due to airway obstruction and V/Q mismatch

What starts the pathophysiology of emphysema?

desctruction of protease and elastase balance causing damages to alveolar walls 

What happens to the alveoli in emphysema?

alveoli distend and lose elasticity causing less surface area for gas exchange

How does emphysema affect ventilation/perfusion (V/Q) matching?

air gets trapped → V/Q mismatch → poor oxygen exchange

What are the consequences of V/Q mismatch in emphysema?

hypercapnia (high CO2), low oxygen, and breathing difficulty

What are the common physical signs of emphysema?

pursed-lip breathing - helps keep airways open

barrel-shaped chest - lungs chronically overinflated 

Why to patients with COPD, especially emphysema, purse their lips when exhaling?

pursed-lip breathing creates back pressure in the airways to keep them open longer which helps air flow out slowly and prevents airway collapse 

why are patients with emphysema less likely to become tachypneic?

slow exhalation from pursed lip breathing reduces the need for rapid breaths, helping them maintain oxygen and CO2 balance

How can COPD cause polycythemia? (abnomal high RBC)

chronic low oxygen causes kidneys to release erythropoietin that causes bone marrow to make more RBC causing polycythemia 

Why can high-flow supplemental oxygen by risky in severe COPD with chronic hypercapnia?

these patients rely on low oxygen levels to to breathe due to hypoxic drive 

What happens to FEV1 in Obstructive airway disease?

descreases - less air can be exhaled in 1 second due to airway obstruction

What happens to FVC in obstructive airway disease?

usually normal or slightly reduced

What happens to the FEV1/FVC ratio in pbstructive airway disease?

decreases - hallmark of obstructive disorders 

what happens to total lung capacity in obstructive airway disease?

increases in diseases like emphysema due to air trapping

what are common causes of pneumothorax?

spontaneous, trauma, latrogenic (medical procedure)

Signs and symptoms of pneumothorax

sudden chest pain, SOB, descreased breath sounds on affected side sometimes hypotension or tachycardia 

What are common causes of pleural effusion?

heart failure, pneumonia, malignancy, liver or kidney disease

What are signs and symptoms of pleural effusion?

dyspnea, descreased breath sounds, dull percussion, sometimes pleurtic chest pain

What is a traumatic pneumothorax?

air enters the pleural space due to injury or trauma (ex. stab, GSW, rib fracture, medical procedure) 

What is tension pneumothorax?

a type of dramatic pneumothorax where air enters but can’t scape, building pressure, causing lung collapse, mediastinal shift and hypotension *life threatening 

What is an open pneumothorax?

a type of tramatic pneumothorax where there is a whole in the chest wall, causing air to move in and out freely, can collapse lung, but pressure doesn’t build

What is a spontaneous pneumothorax?

air enters the pleural space without trauma, often from ruptured blebs in teh lungs