The lung is innervated by the parasympathetic nervous system via what nerve?
Vagus; Fibers of the sympathetic division of the autonomic nervous system (ANS) in the lung branch from the upper thoracic and cervical ganglia of the spinal cord. Fibers of the parasympathetic division of the ANS travel in the vagus nerve to the lung
Chest wall restriction results in
Hypoventilation, inability to remove secretions, hypoxemia, and decrease in tidal volume; Many patients progress to hypercapnic respiratory failure; Mechanical ventilation may be indicated
Flail chest results from the
Fracture of several consecutive ribs, or fracture of sternum and consecutive ribs
Fracture of several consecutive ribs results in
Instability of a portion of the chest wall pardoxic movement of chest with breathing; During inspiration, unstable portion of chest wall move inward, it depresses instead of enlarging; During expiration, unstable portion of chest wall balloons outwards
What is one of the most common lung disorders in the U.S., and is one of the few that is increasing in prevalence?
Chronic bronchitis and emphysema occur together frequently. Whereas both occur in combination frequently, the term is
Chronic obstructive pulmonary disorder (COPD)
The unifying symptom of obstructive lung disease is
The unifying sign of obstructive lung disease is
The major pathologic feature of asthma is
Inflammation resulting in hyper-responsiveness;
Exposure to allergens, with subsequent immunologic activation in the atopic individual with production of interleukins and IgE results in
Mast cell degranulation, and release of histamine, interleukins, prostaglandins, leukotrienes
Vasoactive effects of the cytokines released include
Vasodilation and increased capillary permeability
Impaired expiration causes air trapping and hyperinflation distal to obstruction. Hyper-ventilation is triggered by lung receptors responding to hyperinflation and causes
Decreased CO2, and increased pH (alkalosis); However, as the obstruction becomes more severe, there is hypo-ventilation (decreased tidal volume), CO2 retention and respiratory acidosis
What signals respiratory failure?
Asthma affects the bronchi not the
Severe asthma attacks involve
Wheezing heard during inspiration and respiration; use of accessory muscles (intercostals, cervical muscles, serratus anterior, SCM muscles), yet when the muscles get tired, the person can go into respiratory arrest, pulsus paradoxus
Also parasoxic pulse or paradoxical pulse; It is a abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration; Normal fall in pressure is less than 10 mmHg; When the drop is more than 10 mmHg, it is referred to this
Pulsus parsdoxus is not related to
Pulse rate or heart rate, and it is not a paradoxical rise in systolic pressure; The normal variation of blood pressure during breathing/respiration is a decline in blood pressure during inhalation and an increase during exhalation
Pulsus paradoxus is a sign that is
indicative of several conditions, including caridac tamponade, pericarditis, chronic sleep apnea, croup, and obstructive lung disease (i.e., asthma and COPD)
Asthma is intitiated by what type of hypersensitivity reaction?
Changes in the alveoli that cause an decrease in alveolar surface tension, alveolar collapse, and decreased lung expansion are a result of
Decreased surfactant production
Which statement is true regarding alveoli?
The alveoli begin to increase in size starting at 8 years of age; The complexity of the alveoli increases into adulthood; and Capillaries are the origin of alveoli; The number of alveoli continues to increase during the first 5 to 8 years, after which the alveoli increase in size and complexity
An area where alveoli are ventilated yet not perfused is termed
Alveolar dead space
An example of which pulmonary disorder causes alveolar dead space is
Pulmonary emboli, as it impairs blood flow to the segment of the lung
Pressure in the pleural space is
The movement of gas and air into and out of the lungs is called
Nasal problems, foreign body, polyps, or choanal atresia
Which immunoglobulin may contribute to the pathophysiology of asthma?
The pulmonary defense mechanism that propels a mucous blanket entrapping particles moving towards the oropharynx are the
Communication between the aorta and the pulmonary artery
Sitting up in a forward-leaning position generally relieves which breathing disorder?
Orthopnea; Generally relieved by sitting up in a forward-leaning posture or supporting the upper body on several pillows
Kussmaul respirations as a respiratory pattern may be associated with which characteristic(s)?
Slightly increased ventilatory rate, large tidal volumes, and no expiratory pause; These respirations are not associated with alternating periods of deep and shallow breathing, pulmonary fibrosis, and chronic obstructive pulmonary disease
Respirations that are characterized by alternating periods of deep and shallow breathing are a result of which respiratory mechanism?
Decreased blood flow to the medulla oblongata; Alternating periods of deep and shallow breathing are characteristic of Cheyne-Stokes respira- tions and are the result of any condition that slows the blood flow to the brainstem, which in turn slows impulses that send information to the respiratory centers of the brainstem
With a total hemoglobin of 9 g/dl, how many grams per deciliter of hemoglobin must become desaturated for cyanosis to occur?
5; Generally it develops when 5 g/dl of hemoglobin is desaturated, regardless of hemoglobin concentration
Which statement is true regarding ventilation
Hyperventilation causes hypocapnia
Clinical manifestations of inspiratory and expiratory wheezing, dyspnea, nonproductive cough, and tachypnea are indicative of which pulmonary disease?
By what mechanism do pulmonary edema and pulmonary fibrosis cause hypoxemia?
By impairing diffusion through the alveolocapillary membrane; For example, diffusion of O2 through the alveolocapillary membrane is impaired if the alveolocapillary membrane is thickened or the surface area available for diffusion is decreased. Abnormal thickness, as occurs with edema (tissue swelling) and fibrosis (formation o fibrous lesions), increases the time required for diffusion across the alveolocapillary membrane
High altitudes may produce hypoxemia through
Decreased inspired oxygen
The pathophysiology of chronic bronchitis can be explained by which of the following descriptions?
Abnormal permanent enlargement of gas exchange airways with destruction of alveolar walls
Which description is indicative of acute respiratory distress syndrome (ARDS)?
A pulmonary disease characterized by severe hypoxemia, decreased pulmonary compliance, and diffuse densities on chest x-ray
What effect does damage to the type II pneumocytes have in acute respiratory distress syndrome (ARDS)?
Atelectasis and decreased lung compliance
What effect does the release of fibroblast growth factors have in acute respiratory distress syndrome (ARDS)?
In acute respiratory distress syndrome (ARDS), how does diffuse pulmonary thrombosis contribute to pulmonary edema?
By increasing the capillary hydrostatic pressure
In adult respiratory distress syndrome (ARDS), what change causes alveoli and respiratory bronchioles to fill with fluid?
Surfactant is inactivated and type II alveolar cells are impaired, and bronchioles fill with fluid or collapse
What is the primary cause of respiratory distress syndrome (RDS) of the newborn?
A surfactant deficiency
Another definition of Surfactant
Surfactant is a lipoprotein produced by alveolar type II cells, has detergent-like effect that separates liquid molecules. It coats the inner surface of the alveolus and facilitates its expansion during inspiration, lowers alveolar surface tension at end-point expiration, and thereby prevents lung collapse. Decreased surfactant will decrease alveolar surface tension, increase alveolar collapse, and decrease lung expansion
The most successful treatment for asthma involves
Elimination of the causative agent
Clinical manifestations of decreased exercise tolerance, wheezing, shortness of breath, and productive cough are indicative of which pulmonary disease?
What is the effect of inflammatory cytokines, tumor necrosis factor alpha (TNF-alpha), and interleukin 1 (IL-1), in asthma?
They increase levels of acetylcholine, which causes bronchial smooth muscle contraction and mucus secretion
What involves an infected pleural effusion, the presence of pus in the pleural space, and a complication of respiratory infection, usually pneumonia?
Bronchiolitis tends to occur during the first years of life and is most often caused by what kind of infection?
Respiratory syncytial virus (RSV), which is defined as a virus that causes infections of the lungs and respiratory tract; It is so common that most children have been infected with the virus by age 2; It is the major cause of bronchiolitis and pneumonia in young children, and may be a contributing factor in sudden infant death syndrome
Which description is indicative of childhood asthma?
An obstructive airway disease characterized by reversible airflow obstruction, bronchial hyper-reactivity, and inflammation
Which arterial blood gases values would be expected in the acute phase of childhood asthma?
pH 7.5, PaCO2 30 mm Hg, HCO3 26 mEq/L
Right-sided heart failure secondary to pulmonary hypertension is also called
Cor pulmonale; High output failure refers to left or biventricular failure due to high output conditions such as sepsis or anemia; Coronary disease is atherosclerosis of the coronary arteries
My doctor said I have cor pul-something, which is a heart problem, sayd Mr. Garbedian. I thought I just had these bad lungs that can’t be fixed. How can that make my heart go bad? Which mechanism leads to the development of cor pulmonale, which should serve as the basis for your response to Mr. Garabedian?
Increased resistance to pulmonary arterial flow leads to compensatory right ventricular hypertrophy; Left ventricular failure, pneumothorax and compression atelectasis, and cardiac dysrhythmias are NOT part of the pathogenesis of cor pulmonale
Harms the tissues deep in the lungs; The alveoli, and the supporting structures become inflamed and scarred; If scarring progresses, the lungs get thick and stiff, and in doing so, difficulty of catching breath and blood may not get enough oxygen results