HISTORY AND PE SUMMARY 1

Oxygen

What element's concentration in inspired air is decreased in FiO2 (Hypoxemia) mechanism of dyspnea?

FiO2

What is the abbreviation for the Fraction of inspired oxygen?

Carbon monoxide

What compound causes poisoning (Carboxyhemoglobinemia) leading to dyspnea via oxyhemoglobin deficiency?

Oxyhemoglobin

What molecule's deficiency is associated with problems in transfer of oxygen in hemoglobin leading to dyspnea?

Methemeglobineamia

What condition related to hemoglobin causes dyspnea via oxyhemoglobin deficiency?

Cyanide

What specific toxic substance is listed as a cause of oxyhemoglobin deficiency?

Blood

What substance can fill the alveolar sac causing dyspnea?

Pus

What substance can fill the alveolar sac causing dyspnea?

Fluid

What substance can fill the alveolar sac causing dyspnea?

Extracellular fluid

What substance is redistributed from edematous extremities to the lungs with recumbency, contributing to Paroxysmal Dyspnea and Orthopnea?

Capsaicin

What chemical stimuli may initiate the cough reflex?

Neutrophils

What cell type is mixed with blood in Hemoptysis sputum?

Macrophages

What cell type is mixed with blood in Hemoptysis sputum?

Acidic pH

What is the laboratory characteristic of Hematemesis sputum?

Alkaline pH

What is the laboratory characteristic of Hemoptysis sputum?

Chemoreceptors

What sensory receptor type provides afferent feedback to the sensory cortex in dyspnea production?

Mechanoreceptors

What sensory receptor type provides afferent feedback to the sensory cortex in dyspnea production?

Metaboreceptors

What sensory receptor type provides afferent feedback to the sensory cortex in dyspnea production?

Vagus

What nerve transmits sensory signals from receptors in the respiratory system, ear canals, eardrums, pleura, pericardium, diaphragm, esophagus, and stomach to the cough center?

Superior laryngeal nerves

What nerve, besides the vagus, transmits sensory signals from the larynx and airways to the cough center?

Spinal motor nerve

What nerve transmits efferent signals from the cough center to the expiratory muscles, including pelvic sphincters?

Phrenic nerve

What nerve transmits efferent signals from the cough center to the diaphragm?

Vagal irritants/receptors

What type of receptors can generate signals of chest tightness transmitted to the brainstem and sensory cortex?

Vagus nerve

What nerve transmits efferent signals from the cough center to the larynx, trachea, and bronchi, leading to their contraction?

Increases in ventilation

What physiological response to abnormalities of gas exchange or increased work of breathing characterizes the pathophysiology of dyspnea?

Abnormalities of gas exchange and Increased work of breathing

What are the two general physiological responses that increase ventilation and cause dyspnea?

Decreased oxygenation, hypoventilation, hyperventilation

Name two abnormalities of gas exchange that cause dyspnea.

Changes in respiratory mechanics and/or anxiety

What two factors increase the work of breathing, leading to dyspnea?

Effferent (outgoing) and Afferent (incoming) signals

What two signal types interact, leading to the consequence of dyspnea?

Motor output from the brain to the ventilatory muscles

What defines the efferent signal (feed-forward) in dyspnea pathophysiology?

Sensory input from receptors throughout the body

What defines the afferent signal (feedback) in dyspnea pathophysiology?

Afferent information from the receptors throughout the respiratory system projects directly to the sensory cortex

What anatomical pathway contributes to primary qualitative sensory experiences of dyspnea?

The motor cortex sends neural messages to the ventilatory muscles and a corollary discharge to the sensory cortex

What defines the feed-forward mechanism of the motor cortex in dyspnea pathophysiology?

An error signal is generated

What is the consequence if the feed-forward and feedback messages do not match in the dyspnea pathway?

The intensity of dyspnea increases

What is the effect of the generation of an error signal?

Chest tightness

What qualitative sensory experience is generated by vagal irritants/receptors and transmitted to the brainstem and sensory cortex?

Hypoxemia or decreased FiO2

What dyspnea mechanism involves the decreased concentration of oxygen in inspired air?

Infections, angioedema, trauma, foreign body, tumors of the neck

Name two causes of airway obstruction in the larynx and trachea.

Bronchitis, asthma, extensive bronchiectasis, bronchial stenosis, retrosternal goiter, aspirated foreign body

Name two causes of airway obstruction in the bronchi and bronchioles.

Alveolar filling with blood, pus, or fluid

What abnormal alveoli mechanism causes dyspnea, leading to conditions like pulmonary edema or pneumonia?

Pulmonary edema from LV failure or acute lung injury, pulmonary infiltrations (pneumonia, carcinoma), pulmonary hemorrhage

Name two causes of alveolar filling.

Atelectasis, pneumothorax, hydrothorax

What conditions cause dyspnea by mechanically compressing the alveoli?

Fibrosis

What condition causes dyspnea via the mechanism of alveolar distraction?

Paralysis of the respiratory muscles or thoracic deformities

What describes the mechanism of Restrictive chest and lung disease causing dyspnea?

Pulmonary thromboemboli and infarction

What specific problems with blood vessels cause dyspnea via Abnormal pulmonary circulation?

Anemia, carbon monoxide poisoning (Carboxyhemoglobinemia), Methemeglobineamia, Cyanide

Name two conditions associated with Oxyhemoglobin deficiency causing dyspnea.

Pain from respiratory movements, Hyperventilation syndrome (Panic attack), Secondary respiratory alkalosis (Increased intracranial pressure, metabolic acidosis)

Name two Abnormal respiratory stimuli causing dyspnea.

Transient increase in pulmonary capillary pressure

What physiological event is associated with Paroxysmal Dyspnea?

Redistribution of fluid from edematous extremities to the lungs with recumbency

What fluid change contributes to Paroxysmal Dyspnea and Orthopnea?

Ischemia-induced transient decreases in left ventricular performance

What cardiac effect is associated with Paroxysmal Dyspnea?

Elevation of the diaphragm from obesity or ascites

What mechanism contributes to Orthopnea?

Hyperinflated lung with diaphragm positioned downwards

What CXR finding causes dyspnea in COPD-Emphysema due to difficulty in taking further breaths?

Air filling the lungs

What causes the collapse of the right lung in Pneumothorax?

Lesser area for oxygenation

What is the direct cause of dyspnea in Pneumothorax?

Sudden, forceful, noisy expulsion of the air from the lungs

What is the pathophysiology/definition of cough?

Reflex response

What is the classification given to cough?

Preliminary inspiration, Glottal closure and contraction of respiratory muscles, Sudden glottal opening

What are the three stages of coughing?

A cough reflex arc

What mechanism generates every cough?

Activation (irritation) of cough receptors located in airways, ear canal, pleura, etc.

What is the first step in the cough reflex arc physiology?

Chemical (e.g., capsaicin) and mechanical (e.g., particulates in air pollution) stimuli

Name two types of stimuli that may initiate the cough reflex.

Exudates in the pharynx or bronchial tree, irritation of foreign bodies and inflammation

Name two specific stimuli to coughing listed.

Stimuli will trigger the sensory/ afferent nerve endings

What event follows the activation of cough receptors in the cough reflex arc?

Sensory signals travel via the vagus and superior laryngeal nerves to a region of the brainstem in the nucleus tractus solitarius

What is the pathway for afferent signals to the cough center?

CNS cortical modulation

What allows for voluntary coughing even without activation by irritation?

Efferent signals from the cough center will travel via the spinal motor nerve to the expiratory muscles, including pelvic sphincters

What pathway explains why patients accidentally urinate while coughing?

Efferent signals from the cough center will travel via the phrenic nerve to the diaphragm

What pathway controls the diaphragm during the cough reflex?

Efferent signals from the cough center will travel via the vagus nerve to the larynx, trachea, and bronchi

What pathway controls the contraction of upper airways during the cough reflex?

Acute RTI, Acute exacerbation of COPD, pneumonia, and pulmonary embolism

Name two most common causes of Acute Cough.

Post-infectious cough, bacterial sinusitis, asthma

Name two possible causes of Subacute Cough.

Tuberculosis (TB), Upper airway cough syndrome (UACS), Asthma, Gastroesophageal reflux cough (GERC)

Name two causes of Chronic Cough.

Lung cancer, laryngeal cancer

Name two neoplastic causes of cough.

Inhaled allergens, asthma, chronic bronchitis, vasculitis

Name two inflammatory/immune causes of cough.

CHF, pulmonary embolism, and infarction

Name two vascular causes of cough.

Tobacco smoking, ACE inhibitors

Name two metabolic/toxic causes of cough.

Coughing up of blood from the lungs

What is the definition of Hemoptysis?

Absence of nausea and vomiting

What is the history characteristic of Hemoptysis?

Presence of nausea and vomiting

What is the history characteristic of Hematemesis?

Bronchial arteries proliferate and enlarge to replace the pulmonary circulation

What structural change occurs in bronchial arteries due to chronic hypoxemia and/or chronic inflammation?

Erosion by a bacterial agent, Elevated regional blood pressure

Name two factors that may cause enlarged bronchial vessels to rupture.

Extravasates into the respiratory tree

What is the result when enlarged bronchial vessels rupture, causing massive hemoptysis?

TB, bronchiectasis, and tumor/carcinoma

What are the top three causes of Massive Hemoptysis?

Irritation of nerve endings of pain fibers in the costal pleura

What is the cause of Pleuritic Chest Pain?

Stretching of the inflamed parietal pleura or separation of fibrous adhesions between two pleural surfaces

What specific mechanism causes Pleural pain?

Pain is intensified by breathing, coughing, and laughing

What action intensifies Pleuritic Chest Pain?

Lung parenchyma

Where are sensory nerve endings absent, explaining the lack of chest pain in conditions like Bronchiectasis?

Ruptured bleb – air accumulates, pushing the trachea and mediastinum to the contralateral side

What mechanism causes Tension Pneumothorax?

Hypotension

What circulatory manifestation occurs in Tension Pneumothorax due to compromise heart filling?

Local lag or impairment in respiratory movement

What effect indicates underlying disease of the lung or pleura during chest expansion assessment?

Ipsilateral

What direction is the tracheal deviation in Atelectasis?

Contralateral

What direction is the tracheal deviation in Massive pleural effusion or Tension Pneumothorax?

During speech, patient’s vocal cords set up vibrations in the bronchial air column that are conducted to the chest wall thru the lung septae

What physiological process causes Tactile Fremitus?

Consolidation (e.g., pus in the lungs due to pneumonia)

What condition causes an increase in tactile fremitus?

Blockage of the airways, Sound screens of fluid or air in pleural cavity, Fibrosis of pleura

Name two conditions that cause a decrease in tactile fremitus.

Underlying tissues vibrate to produce percussion notes that vary with the density of the organ and the composition overlying tissue

What mechanism produces percussion notes?

Paralysis or emphysema

What two conditions may cause decreased or asymmetric diaphragmatic excursion?

Turbulent air flow produced by the structures of the lungs during breathing

What mechanism produces breath sounds?

Air-filled lung has been replaced by fluid-filled or solid lung tissue

What must be suspected if bronchovesicular or bronchial breath sounds are heard in distant locations?

Air is forced through respiratory passages that are narrowed by fluid, mucus, or pus

What is the cause of Crackles/Rales?

Airway opening and secretions in the airway

What specific causes are associated with Coarse Crackles?

Airway secretions and narrowing

What causes Rhonchi?