Castilla Pulmonary Pathophysiology

Question 1

5 Classes of Pulm. Htn?

Answer 1

1. PAH
2. L. heart probs
3. Breathing disease/Hypoxia probs
4. Clots
5. Multi-factorial

Question 2

5 Driving forces for ventilation (most to least sensitive)

Answer 2

1. Co2
2. O2
3. pH
4. Stretch
5. Pain

Question 3

What happens to the V:Q in Emphysema?

Answer 3

Stays the same because you’re dipping ventilations AND perfusion function

Question 4

What happens to the o2/FiO2 ratio upon O2 administration during ARDs?

Answer 4

Doesn’t change, because the membrane is wrecked.

Question 5

Panacinar vs Centriacinar damage from emphysema?

Answer 5

• Para= Entire Acinar Unit

- Centri= More proximal

Question 6

Expiratory Accessory muscles?

Answer 6

Stomach muscles and Internal Intercostals

Question 7

Two types of Restrictive Lung disease?

Answer 7

1. Extrinsic: Chest wall, nerve, Structural

2. Intrinsic: Lung tissue, scarring, Toxins, (Sarcoidosis)

Question 8

Patient 1 has clubbing

Patient 2 has flattened diaphragm with barrel chest; thoughts on each patient?

Answer 8

1: Club= Bronchitis
2: Dia/Barrel= Emphy

Question 9

Shunt vs Dead space?

Answer 9

• Shunt V=0

- Dead space Q=0

Question 10

Bronchitis vs Emphysema: Which one causes early onset of DYSPNEA and why?

Answer 10

Emphysema because the tissue is getting wrecked, whereas bronchitis can still rely on a lot of the functional healthy tissue.

Question 11

Inspiratory Accessory muscles?

Answer 11

Mainly Neck

Question 12

What happens to the V:Q in Bronchitis?

Answer 12

V goes down, Q stays mostly Okay.

Question 13

Pulmonary HTN

Answer 13

> 25 Pulm. Art Pressure

- Smooth Muscle and Vasoconstrictors close up blood flow

Question 14

In obstructive lung disease, pts. have a lot of trouble with expiration, how will the flow volume curve present?

Answer 14

• Shallow and lengthened on top Expiratory Curve

- Relatively normal on inspiratory curve

Question 15

What does IPPA stand for?

Answer 15

• In reference to lung exam

- Inspection, Palpation, Percussion, Auscultation

Question 16

Respiratory conducting airways go up to the ____ branch, which then leads into the terminal bronchioles

Answer 16

16th

Question 17

Bronchitis vs Emphysema: Which one has greater airway resistance?

Answer 17

Bronchitis b/c tissue still in tact and getting flooded, (also why it’s more likely to cause Cor Pulm)

Question 18

Two main types of Obs. Lung diseases?

Answer 18

1. Asthma

2. COPD

Question 19

BMPR2 has been linked to causing which class of Pulm. HTN?

Answer 19

Class 1; PAH

Question 20

Two things that can’t be determined directly from PFTs?

Answer 20

TLC and RV

Question 21

Emphysema mnemonic and why?

Answer 21

• Pink puffer
• b/c you still get good O2 until the end
• pts purse lips for PEEP

Question 22

What muscles are used during normal, calm, Inspiration?

Answer 22

Diaphragm and External Intercostals

Question 23

How much of lung volume is dead space?

Answer 23

About 1/3

Question 24

Chronic Bronchitis mnemonic and why?

Answer 24

• Blue Bloater

- b/c hypoxia

Question 25

Lower lung border on anterior is which rib?

Answer 25

Rib Number 7

Question 26

ARDs

Answer 26

- Acute Respiratory Distress | - Injured Membrane

Question 27

Four main things that cause Pulmonary Vascular Disease>?

Answer 27

1. Embolism 2. HTN 3. Edema 4. Infarction

Question 28

What muscles are used during normal, calm, experiation?

Answer 28

don't really need muscles

Question 29

Virchows Triad?

Answer 29

1. Stasis 2. Coag 3. Injury

Question 30

2 chemical mediators that cause asthma's symptoms?

Answer 30

1. Ach | 2. Leukotriene

Question 31

Two stages of ARDS

Answer 31

1. Exudative & Hyaline (wk.1) | 2. Proliferative/fibrotic (past wk1)

Question 32

The pt. has a resp. disease and you see elevated RV and TLC, what class of disease does the pt. have?

Answer 32

Obstructive b/c Gas-trapping

Question 33

Ventilation

Answer 33

The air traveling through: 1. Active Inspiration 2. Passive Expiration

Question 34

Best way to diagnose Pulm. HTN?

Answer 34

- Pulm. Art. Catheterzation - P>18 = Cardi - P<18= Non-Cardi

Question 35

What happens to the FEV1:FVC in Obst. Lung disease and why?

Answer 35

- The ratio goes down - The obst. mainly causes trouble with expiration, which directly lowers the FEV1 - Not much problem with filling

Question 36

How is the lower Respiratory airway divided?

Answer 36

- Trachea and Beyond

Question 37

Normal Arterial levels for ph, O2, CO2, HCO3?

Answer 37

- pH 7.35-7.45 - O2 75-100 - CO2 35-35 - HCO3 22-26

Question 38

Non-Cardiogenic Pulm. 3 Distinguishing Features

Answer 38

- Barrier Problem - Exudate - Restrictive PFT pattern

Question 39

Cardiogenic Pulm. Edema 3 Distinguishing Features

Answer 39

- Pressure Problem - Clear Fluid - Elevated BNP

Question 40

In restrictive lung disease, patients get rid of their lung content quicker because there's less. How will the flow-volume graph present?

Answer 40

Steep and Squished

Question 41

Lower lung border on posterior is which rib?

Answer 41

Rib Number 10

Question 42

Restrictive Lung disease is driven by _____

Answer 42

Decreased Compliance

Question 43

4 spots to listen to the Right lung in the anterior?

Answer 43

1. Apex 2. Superior Lobe 3. *Middle Lobe* 4. Inferior lobe

Question 44

Best way to prove Class 2 Pulm HTN?

Answer 44

Increased Cap Wedge Pressure

Question 45

What happens to the FEV1:FVC in Rest. Lung Disease and why?

Answer 45

Stays the same b/c total and vital go down since it can't reach full expansion.

Question 46

Histological give-away for PAH?

Answer 46

Onion rings