Exam 3 patho

What defines heart failure?

What defines heart failure?

Heart failure is the inability of heart to maintain sufficient cardiac output to meet metabolic demands of tissues and organs

True or False: The mortality for HF is high, 50% of patients die within 5 years of diagnosis

True

What are the most common causes of HF?

Myocardial ischemia (CHD) followed by hypertension and dilated cardiomyopathy

When it comes to Systolic Dysfunction with low ejection fraction, what is reduced contractility evidenced by?

Reduced contractility evidenced by low ejection (EF) and reduced muscular contraction during ventricular systole

What is the hallmark of diastolic dysfunction with preserved ejection fraction?

The hallmark is that patient exhibits low cardiac output, congestion, and edema formation with normal ejection fraction (EF)

What is increased preload defined as?

Increased preload is a compensatory mechanism that enhances the ability of the myocardium to contract more forcefully

What is the difference between forward and backward failure?

Forward failure is insufficient cardiac pumping manifested by poor cardiac output. The backward failure is the congestion of blood behind the pumping chamber.

True or False: Biventricular heart failure is most often the result of primary left ventricular failure that has progressed to right sided heart HF

True

What is the cardinal sign associated with left HF?

Pulmonary congestion

True or False: Beta blockers inhibit SNS effects

True

What are dysrhythmias significant for?

They are significant for indicating an underlying pathophysiologic disorder, and for impairing normal cardiac output

What are factors that cause dysrhythmia?

Hypoxia, electrolyte imbalance, truma, inflammation, and drugs

What is the difference between tachycardia and bradycardia?

Tachycardia is fast heart rate whereas bradycardia is slow heart rate

What is the difference between sinus arrhythmia and sinus arrest?

Sinus arrhythmia is a degree of variability in the heart rate whereas sinus arrest is a flat trace for a period of a few seconds

True or False: Escape rhythms are associated with low cardiac output

True

What are the structures of the upper airway?

Upper airway: nasopharynx, oropharynx, laryngopharynx

What are the structures of the lower airway?

Lower airway: larynx, trachea, bronchi, bronchioles, alveoli

What does the nasal cavity function in?

Conducts gases to and from the lungs; filters, warms, and humidifies the air; heat exchange system

What is ciliary function imparied by?

Ciliary function impaired by smoking, alcohol, hypothermia, hyperthermia, cold air, low humidity, starvation, anesthetic, corticosteroids, noxious gases, the common cold, increase mucus production

Where is the eustachian tube located?

Tube between the middle ear and the posterior nasopharynx

True or False: Gas exchange occurs in the conducting airways.

false , no gas exchange occurs in the conducting airways

What are the conducting airways?

Trachea, bronchi, and bronchioles

What do the conducting airways help assist in?

Involved in the passage of gases to the alveoli where gas exchange occurs

Alveolar macrophages do what?

Alveolar macrophages phagocytize foreign particles

True or False: Type II alveolar cells produce surfactant

True

What are the partial pressures of gases in alveoli?

PAO2 for oxygen and PACO2 for carbon dioxide

What are the partial pressures of gases in the blood?

PaO2 and PaCO2

Blood supply to the lungs comes from where?

Bronchial arteries and pulmonary arteries

What is the function of the bronchial arteries?

Bronchial arteries supply small amount of oxygenated blood to pleura and lung tissues

What is the function of the pulmonary arteries?

Pulmonary arteries vast network of capillaries that provide for gas exchange

What happens once blood leaves the right ventricle?

Blood from the right ventricle goes to the pulmonary arteries (unoxygenated) and then to pulmonary arterioles to the capillary membrane for gas exchange

True or False: The respiratory system in children is significantly different from that of adults which makes children more susceptible to obstruction, aspiration and infection.

True

True or False: Vital capacity is the volume of gas that can be exhaled during maximal expiration.

True

What does surfactant function in?

Surfactant decreases surface tension, allowing the alveoli to open easily with each breath.

What happens during inspiration?

Inspiration, the chest wall muscles contract, elevating the ribs as the diaphragm moves downward creating a negative intrapleural pressure

What happens during expiration?

During expiration, lung deflates passively because of elastic recoil and relaxation of the diaphragm

Airway resistance is provided from?

Radius of airways, elastic fibers, surface tension in the alveoli

True or False: Chemoreceptors respond to changes in arterial CO2 and pH

True

Normal perfusion, but low alveolar ventilation causes?

Collapsed lung, pneumonia, ARDS

True or False: Thickening of the alveolar-capillary membrane cannot cause impaired diffusion.

False, it can

Hypoxemia is defined as?

Deficient blood oxygen as measured by low arterial O2 and low hemoglobin saturation

Hypoxia is defined as?

Hypoxia is a decrease in tissue oxygenation

Acute Respiratory Failure (ARF) results in?

State of disturbed gas exchange results in: low PaO2, high PaCO2 greater than 50 mmHg, pH less than 7.30

What are the three mechanisms of secondary pulmonary HTN?

Increased pulmonary blood flow, increased resistance to blood flow (most common and usually due to hypoxic vasoconstriction), increased left atrial pressures

What is one way to diagnose pulmonary hypertension?

ECG (there are more!)

Describe a pulmonary embolism?

An undissolved detached material (blood clot, fat emboli, amniotic fluid, air, tumor, foregin bodies, spetic, parasites) that occlude blood vessels

What are the 3 factors that Virchow said cause thrombus formation?

Venous stasis/sluggish blood flow, hypercoagulability, damage to the venous wall

(intimal injury)

What are the four major types of pulmonary malignancies?

Large cell carcinoma, small cell carcinoma, squamous cell carcinoma, adenocarcinoma

True or False: Obstructive lung diseases are manifested by increased resistance to airflow.

True

What is asthma characterized by?

Characterized by airway obstruction that is reversible (not completely in all patients), airway inflammation, increased airway responsiveness to a variety of stimuli

What are the two types of asthma?

Intrinsic (non-allergic), extrinsic (allergic)

Which immunoglobulin mediates extrinsic asthma most commonly?

IgE

What are some inflammatory mediators?

Histamine, leukotrienes(anaphylactic), cytokines (released by T cells)

What is the pathogenesis of asthma?

Normal respiratory epithelium replaced goblet(mucus-producing) cells results in mucosal edema, inflammatory exudates, hyperresponsiveness of the airway

What is acute bronchitis?

Acute inflammation of the trachea and bronchi

What is the distinct hallmark of acute bronchitis?

Recent onset of cough

True or False: Inhaled short-acting B2 agonists is given to cause bronchodilation for patients with chronic bronchitis.

True

What is the etiology of emphysema?

Destructive changes of the alveolar walls without fibrosis, abnormal enlargement of the distal air sacs, and the damage is irreversible

True or False: Radial traction is normally used to hold the airway open.

True

Bronchiectasis is defined as?

Obstruction of bronchi due to inflammation, infection, and dilation of the bronchial wall of medium sized bronchi and bronchioles

Bronchiolitis is defined as?

Bronchiolitis is the widespread inflammation of bronchioles as a result of infectious agents

The etiology of croup syndrome is from?

A number of acute, viral inflammatory diseases of larynx, trachea, and bronchi

What do restrictive pulmonary diseases result from?

Result from decreased lung expansion

What is interstitial lung disease characterized by?

It is characterized by thickening of alveolar interstitium

Persistent alveolitis leads to?

It leads to obliteration of alveolar capillaries, reorganization of lung parenchyma, irreversible fibrosis

In interstitial pulmonary fibrosis, lung tissue becomes infiltrated by?

In interstitial pulmonary fibrosis, lung tissue becomes infiltrated by lymphocytes, macrophages, and plasma B cells

Sarcoidosis is defined as?

Sarcoidosis is a restrictive disorder associated with abnormal protein deposits in the lung

True or False: In hypersensitivity pneumonitis, antibodies are produced in response to inhaled particles.

True

True or False: Occupational lung disease results from chronic inhalation of gases and inert particles.

True

What is pneumoconiosis made up of?

Coal, silica, asbestos

Acute Respiratory Distress syndrome, is a consequence of?

ARDS is a consequence of widespread pulmonary inflammation damaging the alveolar-capillary membrane leading to 3 major pathophysiologic processes

What is a pulmonary edema shown as on a chest radiograph?

Evident as diffuse “whiteout”

Infant Respiratory Stress Syndrome(IRDS) occurs most commonly in?

Occurs most commonly in premature infants born before development of surfactant-producing cells (less than 32 wks of gestation)

True or False: Accumulation of air in the pleural space is called pneumothorax and can’t resist lung expansion.

False, it can restrict lung expansion

Which type of pneumonia produces exudate?

Bacterial

What is the manifestation of bacterial pneumonia?

Includes fever, chils, cough and purulent sputum

What causes respiratory syndrome?

COVID-19 coronavirus

What causes Pulmonary Tuberculosis?

Mycobacterium tuberculosis

True or False: Ankylosing spondylitis is a nonprogressive inflammatory disease.

False, it is progessive and leads to immobility of vertebral joints and fixation of the ribs

Where does body fluid flow in?

Flows in arteries, veins, and lymph vessels

What are the locations of extracellular fluid?

interstitial(between cells), vascular (blood vessels), in dense connective tissue and bone, and transcellular fluid (synovial, cerebrospinal, and GI fluids)

How would you describe the roles of fluid homeostasis?

Fluid intake, fluid absorption, fluid distribution, and fluid excretion

Thirst is triggered by?

Increased concentration of extracellular fluid, decreased circulating blood volume, dryness of the mucous membrane

By which pressures force the fluid from the vascular compartment to go in between the cells?

Capillary hydrostatic pressure (outward pushing vascular fluid against vessel wall) and interstitial fluid colloid osmotic pressure (inward-pulling force of the particles in the interstitial fluid)

True or False: Capillary forces move fluid from the interstitial compartment into capillaries.

True

True or False: Water moves in and out of the cells by passive diffusion.

False, water moves in and out of the cell by osmosis

Does water move to the lower osmolarity?

No, moves to higher

What are the two components that indicate body fluid balance?

Urine volume and concentration

ADH causes the kidney to?

ADH causes the kidneys to retain water (not salt)

What are the two major categories of fluid imbalances?

Imbalances of extracellular fluid volume which is saline imbalances (imbalance of amount of ECF) and imbalances of body fluid concentration which is water imbalance (imbalance concentration of ECF)

EC volume deficit presents itself as?

Fluid loss from the vascular and interstitial areas can result in sudden weight loss, BP decrease with a concurrent HR increase, flat neck veins, dizziness, etc

What are the causes of EC volume excess?

1) caused by the addition or retention of isotonic saline

2) excessive secretion of aldosterone causes kidneys to retain too much saline

True or False: Imbalances are disorders of concentration and not the amount of ECF.

False

What are primary causes that cause hyponatremia?

A gain of relatively more water than salt, and a loss of relatively more salt than water

Do cells shrivel in hypernatremia?

Yes

How would you classify an edema?

Excess fluid in the interstitial compartment

Cells contain higher concentrations of?

Potassium, magnesium, and phosphate ions

Extracellular fluid contains higher concentration of?

Sodium, chloride, calcium, and bicarbonate ions.

When is electrolyte absorption beneficial?

Absorption is essential if electrolyte is to be useful metabolically

Hormones, such as Epinephrine, Insulin, and Parathyroid hormone cause?

Cause mobilization of electrolyte into the bloodstream