week 9-2

Question 1

ventilation- perfusion ratio

Answer 1

the amount of air getting to the alveoli relative to amount of blood getting there

Question 2

respiratory system will always match

Answer 2

ventilation and perfusion

Question 3

obstructive lung disease

Answer 3

• ventilation is obstructed(usually due to increased resistance to airflow)
• asthma

Question 4

restrictive lung disease

Answer 4

-reduced lung compliance- increase- stiffness- limited expansion
-pulmonary fibrosis

Question 5

vascular disorder that impairs gas exchange

Answer 5

• pulmonary edema
• pulmonary embolism

Question 6

increased resistance to airflow due to ???

Answer 6

reduced airways radius

Question 7

obstructive lung disease volume levels statis

Answer 7

-increase in residual volume and increase in expiratory reserve volume
decrease in inspiratory reserve volume

Question 8

restrictive lung volume levels

Answer 8

decrease expiratory and inspiratory reserve volume

Question 9

Dynamic force vital capacity (FVC) Obstructive

Answer 9

• blowing out is harder
• takes a lot longer to get the air out
  -FEV1 is lower (<0.7)

Question 10

Dynamic force vital capacity (FVC) restrictive

Answer 10

-can’t get as much air exchange in the lung
-FEV1 is higher (0.75-0.9)
-shorter breaths

Question 11

FEVi/FVC = (normal)

Answer 11

0.8

Question 12

Flow-Volume Loops in Obstructive

Answer 12

All flow rates diminished, Volumes:
increased RV; Decreased VC, IRV, ERV

Question 13

Flow-Volume Loops in restrictive

Answer 13

Flow rates normal, Lung volumes:
Decreased RV, VC

Question 14

Which of the two lead to an increased residual
volume due to ‘air trapping’?

Answer 14

obstructive

Question 15

Which of the two display a more normal flow rate
but an inability to fully inflate the lungs?

Answer 15

restrictive

Question 16

asthma

Answer 16

• bronchial obstruction due to hypersensitive and/or hyperresponsive immune response
  -reversible but chronic asthma can cause irreversible damage (COPD)
  -Allergic (extrinsic) or Non-Allergic (intrinsic)

Question 17

asthma universal response

Answer 17

• Inflammation & edema of
  mucosa
• Bronchoconstriction
• Increased secretion of thick
  mucus within airways

Question 18

asthma symptoms

Answer 18

• Coughing, wheezing,
  shortness of breath
• Rapid breathing
• Rapid heart rate
• Cough up thick mucus

Question 19

Allergic (Extrinsic)

Answer 19

• more commonly manifests in childhood
• hypersensitivity reaction triggers an immune response
• triggered by inhaled allergens such as dust mite allergens

Question 20

reduced alveolar elastic recoil (emphysema)

Answer 20

airways are tethered to surrounding alveoli. when alveoli inflate airways are forced to dilate also
(radial traction)

Question 21

nonallergic (intrinsic)

Answer 21

• More commonly manifests in
  adulthood
• Hyperresponsive reaction to
  certain stimuli
• Triggered by factors such as
  anxiety, stress, exercise, cold air,
  dry air, hyperventilation, viruses,
  smoke, other irritants.

Question 22

the first stage of asthma

Answer 22

-sensitized mast cells within the respiratory mucosa regonize antigen
- release of chemical mediators
- inflammation bronchoconstriction,
edema, increased mucus secretions
- also stimulates vagus nerve- reflex bronchoconstriction

Question 23

The second stage (within a few hours)

Answer 23

• Increased leukocyte infiltration
   Increased release of chemical mediators
   Prolonged inflammation, epithelial
  damage bronchoconstriction, and
  airway obstruction (partial or total)

Question 24

Partial Obstruction

Answer 24

• some air passes through the obstruction
• less ability to move air out resulting in air trapping. attempting to forcefully expire can lead to collapse of the bronchial wall
• Residual Volume Increases  Less fresh air
  inspired, harder to cough out mucus
• Air trapping & hyperinflation over time can
  stretch out alveoli and cause loss of elasticity

Question 25

Total Obstruction

Answer 25

Mucus plugs completely block airflow through the narrowed airway * Air distal to the block diffuses out but is not replaced  Non-aeration and atelectasis of the whole section distal to the block * Hypoxemia causes local vasoconstriction in pulmonary blood vessels (pulmonary hypertension)  increased work load of right side of the heart

Question 26

Asthma Treatment

Answer 26

-Determine triggers and avoid them if possible * Good ventilation is key * Keep healthy to avoid illness * Swimming is a great sport, walking * Inhaler if needed or prophylactically * E.g. Salbutamol  a Beta-2 adrenergic agonist  Bronchodilation * Other meds: anti-inflammatories (corticosteroids), inhibitors of chemical mediator release, long-acting bronchodilators

Question 27

Asthma is considered an Obstructive Pulmonary Disease. Which of the following functional measures would you expect to see?

Answer 27

Lower FEV1 (forced expiratory volume in the first second of expiration)

Question 28

the end goal of asthma

Answer 28

MINIMIZE THE NUMBER AND SEVERITY OF ACUTE ATTACKS

Question 29

chronic obstructive pulmonary disease

Answer 29

-a group of chronic respiratory disorders that causes airways obstruction and progressive tissue degeneration -irreversible and progressive damage to the lungs -develops over time and usually in people over 40 -causes by smoking

Question 30

emphysema

Answer 30

- the destruction of alveolar walls due to smoking or genetics

Question 31

1. breakdown of alveolar walls

Answer 31

decrease SA for gas exchange - loss of pulmonary capillaries alongside the alveolar wall breakdown - altered ventilation perfusions ratio - loss of elastic fibers-- decreased elastance/ increased compliance - decreased radial traction- collapse of small airways

Question 32

2. increases mucus production

Answer 32

- due to chronic inflammation and infection leads to thickening and fibrosis of the bronchial walls

Question 33

3. progressive difficulty with expiration

Answer 33

- air trapping and increased residual volume -overinflation of lungs -ribs remain in inspiratory position and increased anterior-posterior diameter

Question 34

Consequences of Advanced Emphysema

Answer 34

- chronic hypercapnia (high CO2 levels in the blood)  Results in more Hypoxic drive - frequent and more sever infection because secretion are more difficult to remove -pulmonary hypertension and cor pulmonale in later stages

Question 35

Emphysema symptoms

Answer 35

 Subtle at first, but permanent damage is being done - Dyspnea upon exertion at first then at also rest - Hyperventilation with a prolonged expiratory phase - Hyperinflation leading to barrel chest -

Question 36

Emphysema - Diagnosis

Answer 36

Diagnosis is based on chest x-rays and pulmonary function tests - Increased residual volume and TLC, decreased vital capacity, and inspiratory & expiratory reserve volume - FEV1 and FVC reduced

Question 37

emphysema Treatment

Answer 37

- Avoid irritants and infection - Immunizations (flu and pneumonia) - Pulmonary rehab and breathing techniques - Bronchodilators, antibiotics, O2 therapy

Question 38

Chronic Bronchitis

Answer 38

* Chronic irritation of the bronchi due to exposure to inhaled irritants * Cigarette smoke * Industrial or environmental pollution * Exposure leads to inflammation and frequent infections * Result is swollen airways with increased mucus production

Question 39

Chronic Bronchitis – Treatment

Answer 39

* Reduce exposure to irritants, treat infections promptly * Vaccination – flu, pneumonia * Expectorants & chest therapy to help with expelling mucus * Bronchodilators * Low-flow forced O2

Question 40

Chronic Bronchitis – Diagnosis

Answer 40

Diagnosis * Symptoms * Chest X rays * Blood gases

Question 41

chronic symptoms of bronchitis

Answer 41

* Chronic ‘productive’ cough * Secretions are thick and purulent * Most severe in the morning * Dyspnea * Hypoxia, hypercapnia