Pulmonary

Question 1

Viral PNA signs/symptoms

Answer 1

-nonproductive cough
-low grade fever
-low to normal WBC’s
-contagious as long as symptoms
present

Question 2

Bacterial PNA Signs/symptoms

Answer 2

-productive cough
-purulent sputum
-high fever
-high WBC’s
-infiltrates on xray
-not contagious after 48 hrs on
antibiotics

Question 3

What is the compensatory mechanism of the lungs in response to hypoxia?

Answer 3

intrapulmonary arteries constrict, diverting blood to better oxygenated lung segments-optimizes V/Q ratio

Question 4

Diseases with decreased V/Q ratio

Answer 4

-PNA
-Asthma
-ARDS
-Alveolar collapse
-Pulmonary Edema

Question 5

Diseases with increased V/Q ratio

Answer 5

-PE
-Non-embolic obstruction by tumor
-Emphysema
-radiation therapy
-Cardiovascular shock

Question 6

V/Q ratio (ventilation/perfusion ratio)

Answer 6

adequate ventilation and sufficient perfusion of blood
normal value= 4:5 or 0.8

Question 7

What are obstructive lung disorders?

Answer 7

disorders that obstruct airflow, making it difficult to exhale completely
EX) COPD, Asthma

Question 8

What are restrictive lung disorders?

Answer 8

disorders that reduce total lung capacity by limiting lung expansion
EX) pulmonary fibrosis, hypoventilation syndrome (caused by obesity)

Question 9

What type of hypersensitivity rxn is responsible for formation of granulomas in TB?

Answer 9

Type IV

Question 10

What causes cavitation in the lungs in active TB infection?

Answer 10

tissue necrosis-bacteria eat the tissue; hallmark of advanced disease

Question 11

What are the characteristics of TB bacteria?

Answer 11

-Mycobacterium tuberculosis
-acid fast bacilli (rod shaped)
-has waxy cell wall that prevents
phagocytosis

Question 12

Initial Pathophysiology of TB

Answer 12

-Droplets inhaled/travel to alveoli–> macrophages ingest bacteria –> granulomas form (macrophages, t cells, b cells, other immune cells) –> macrophages merge into giant multinucleated cells to further create barrier

Question 13

Latent TB

Answer 13

-contained in granulomas
-asymptomatic/not contagious
becoming immunocompromised can trigger latent TB and it will turn into active infection

Question 14

Active TB symtpoms

Answer 14

-persistent cough
-hemoptysis
-night sweats
-chest pain
-wt loss
-fatigue

Question 15

What are the types of asthma?

Answer 15

-Allergic (triggered by allergens)
-Non-allergic
-Exercise induced
-Occupational (triggered by irritating substances in certain occupations)

Question 16

Role of mast cells in asthma

Answer 16

-degranulate in response to allergen –>
release inflammatory mediators like
histamine, prostaglandins, and
leukotrienes
-drive the early phase of asthma attack

Question 17

Role of leukotrienes in asthma

Answer 17

cause bronchoconstriction, tissue edema (by increasing blood flow & permeability), increase mucus production, attract leukocytes

Question 18

Role of eosinophils in asthma

Answer 18

-levels in the blood can help predict severity of asthma
-can damage bronchial walls
-release cytokines that cause inflammation and can lead to remodeling of the airway

Question 19

Pertinent lab values in asthma

Answer 19

eosinophils >300
Serum IgE >100
Spirometry= FVC1/FVC ratio < 0.70

Question 20

Acid- Base imbalance in asthma

Answer 20

Initially respiratory alkalosis from breathing off too much CO2; progresses to resp. acidosis as pt becomes more tired and cannot ventilate

Question 21

signs/symptoms of asthma

Answer 21

Exp. wheezes
chest tightness
SOB
Tachypnea
Anxiety

Question 22

What is pnuemonia

Answer 22

infection of lung parenchyma

Question 23

What is the cause of the consolidation appearance on x-ray in PNA

Answer 23

d/t increased capillary permeability, fluid, cells, proteins fill alveoli and cause impaired gas exchange- fluid filled alveoli cause consolidation

Question 24

How does Alpha 1 Antitrypsin play a role in emphysema

Answer 24

it is an enzyme that prevents elastase from attacking structural fibers in the lung; deficiency causes alveolar destruction

Question 25

Pathophysiology of Emphysema

Answer 25

Chronic progressive lung disease that damages alveoli; loss of alveolar elasticity leading to air trapping and poor gas exchange

Question 26

Pulmonary fxn tests in emphysema

Answer 26

FEVC1/FVC ratio <0.70 low O2; high CO2

Question 27

Risk factors for Emphysema include

Answer 27

smoking, secondhand smoke, air pollution, environmental exposures

Question 28

Complications of emphysema

Answer 28

-Pulmonary HTN leads to Cor pulmonale (right HF) -Pneumothorax-from bullae rupture -Resp failure-advanced stages

Question 29

S/s of Emphysema

Answer 29

chronic cough SOB pink skin "pink puffer" barrel chest cachectic appearance from wt loss

Question 30

Structural changes in Emphysema

Answer 30

-Bullae formation- lrg air filled spaces from destroyed alveoli -Bronchiole collapse-sm airway collapse d/t loss of structural support -Diaphragm flattens- r/t chronic hyperinflation

Question 31

Pathophysiology of Chronic Bronchitis

Answer 31

-persistent inflammation of the bronchi along with excessive mucus production -thickened bronchial walls and hypertrophy of mucus glands -goblet cells hyperplasia

Question 32

S/s of chronic bronchitis

Answer 32

productive cough SOB Chest tightness Frequent resp infections cyanosis "blue bloaters" clubbing

Question 33

Complications of Chronic brochitis

Answer 33

Secondary polycythemia Pulmonary HTN--> Cor Pulmonale reactive vasoconstriction from hypoxia

Question 34

Lab values for Chronic bronchitis

Answer 34

FEV1/FVC ratio <0.70 ABG- hypoxia/increased CO2 CXR-hyperinflation, airway thickening

Question 35

Which inflammatory cells are involved in chronic bronchitis

Answer 35

Neutrophils- contribute to excess mucus Macrophages CD8 t lymphocytes-elevated in smokers

Question 36

Goblet cells

Answer 36

epithelial cells that fxn to produce mucus become hyperplastic in chronic bronchitis