Pathophysiology Module 16 Exam Review

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Alterations in Pulmonary System

Cheyne-Stokes resirations are characterized by:

Rapid respirations alternating with periods of apnea
Apneic spells alternating with hyperventilation are called Cheyne-Stokes respirations and often occur with neurologic injury or profound metabolic alterations.

Hypertrophy of the nail beds due to chronic hypoxemia is called:

Clubbing
Clubbing is manifested by enlargements at the base of the fingernails.

Hypoventilation results in:

Hypercapnia
Hypoventilation results in increased PaCO2, a condition called hypercapnia.

Respiratory acidosis can result from:

Reduced tidal volumes
Low tidal volumes (hypoventilation) result in C02 retention and respiratory acidosis.

Which of the following conditions causes a decreased drive to breathe that results in hypoxemia and hypercapnia?

Cental nervous system disorders
Central nervous system disorders result in a decreased drive to breathe due to damage to the respiratory centers.

A decrease in tidal volume results in a decrease in:

Minute ventilation
Tidal volume, or the volume of air inspired, is directly related to ventilation. A decrease in tidal volume results in a direct decrease in minute volume and minute ventilation.

Which of the following alterations in serum lab values would indicate that a patient is hyperventilating?

High pH
Rapid ventilation increases CO2 removal from the blood and results in a low PaCO2 and elevated pH (respiratory alkalosis).

Which of the following diseases will result in a ventilation/perfusion (V/Q) mismatch?

Asthma, pulmonary edema and emphysema
All three pulmonary diseases result in V/Q mismatches due to decreased ventilation and/or impaired diffusion of gases at the alveolar/capillary membrane.

The collapse of a previously inflated area of lung tissue is called:

Atelectasis
The collapse of a previously inflated area of lung tissue is called atelectasis.

Coal miners or individuals exposed to asbestos often develop a chronic respiratory condition called:

Pneumoconiosis
Severe inflammation and scarring in the pulmonary tissue due to prolonged exposure to coal dust, asbestos, and other inhaled toxins is called pneumoconiosis.

In acute respiratory distress syndrome (ARDS), alveolar damage and impaired surfactant secretion lead to each of the following problems except:

Air trapping
Alveolar damage and altered surfactant production have no direct effect on the bronchi and therefore cannot cause air trapping.

Why does airway obstruction in chronic lung disease cause hypercapnia?

Airway obstruction causes air trapping
With airway obstruction, air enters the alveoli but has difficulty escaping during exhalation. Air becomes trapped in the alveoli, and expiration must be more forceful and prolonged. When air is trapped, tidal volumes are reduced, causing hypercapnia.

When exposed to inhaled allergens, a child with asthma produces large quantities of:

IgE
During an allergic response (type I hypersensitivity reaction), plasma cells produce large quantities of IgE.

In individuals with asthma, exposure to an allergen leads to which of the following pathophysiological events?

Bronchoconstriction and airway edema
Exposure to an allergen results in mast cell degranulation and release of inflammatory mediators that cause bronchoconstriction and airway edema.

When conducting a physical assessment of an individual during an acute asthma episode, you would expect to observe all of the following except:

Loss of pulsus paradoxus
During an acute asthma episode, pulsus paradoxus increases.

The loss of alpha1-antitrypsin in emphysema results in:

The destruction of alveolar septa and the loss of elastic recoil
The destruction of alveolar septa and the loss of elastic recoil in emphysema lead to the loss of alveolar surface area and the collapse of airways during expiration.

A frequent complication of chronic bronchitis related to the hypersecretion of mucus is:

Recurrent infections
Mucus provides a hospitable enviroment for bacterial colonization.

Pneumonia leads to hypoxemia due to:

The accumulation of exudates and fibrin deposition
The inflammatory response to lung infection results in the accumulation of fibrous exudates, which cause ventilation/perfusion (V/Q) mismatching and impair the diffusion of oxygen at the alveolocapillary membrane.

All of the following physical and laboratory findings are indicative of a bacterial pneumonia except:

a dry cough
A dry cough may occur with viral pneumonia. Bacterial pneumonia usually manifests with a productive cough.

Staff at an inner-city homeless shelter send 46-year-old Henry Ship by ambulance to a local hospital after he begins coughing up blood. On arrival at the emergency room, he is feverish and says that he has felt very fatigued for several weeks. He also reports experiencing night sweats. Mr. Ship's symptoms are most likely caused by:

Tuberculosis
All of Mr. Ship's symptoms are typical of tuberculosis infection (TB). Being homeless and living in a shelter are risk factors for TB since the bacteria are easily transmitted from person to person.

Risk factors for TB include:

Immunosuppression
Immunosuppressed individuals, such as those with HIV, are at high risk for TB, which is easily transmitted by personal contact with infected individuals.

Severe acute respiratory distress syndrome (SARS) is transmitted via which of the following mechanisms?

Droplet inhalation
The particular strain of the coronal virus responsible for SARS is transmitted via inhaled droplets containing the virus or via contact with infected bodily (respiratory) fluids.

What is the World Health Organization's major concern regarding the avian flu, which is caused by the H5N1 virus?

The virus may mutate to a form that can be easily transmitted from person to person.
To date, the H5N1 virus has only been transmitted from birds to humans. If the virus develops an ability to be transmitted among humans, there is a grave fear of a pandemic.

Which of the following patients is at highest risk for developing a pulmonary embolism?

a 67-year-old male hospitalized with a deep vein thrombosis in the femoral vein
The presence of deep vein thrombosis in the lower limb is the most important risk factor for pulmonary embolism. Older age is also risk factor.

Chronic pulmonary hypertension can eventually cause which of the following complications?

Chronic obstructive pulmonary disease
Increased right ventricular afterload from pulmonary hypertension can lead to right ventricular failure. Right ventricular failure due to respiratory disease is also known as "cor pulmonale."

Common sites of metastasis for lung cancer include all of the following except:

The kidneys
Although it may be possible for lung cancerd to metastasize to the kidneys, it is not one of the common sites.

Metaplastic changes to bronchial epithelial tissues are frequently caused by:

Cigarette smoking
Cigarette smoking is the most common stimulus for metaplastic changes in the bronchial epithelium. Although metaplasia is generally reversible, the metaplastic cells can become cancerous if an individual continues to smoke.

Signs and symptoms of dyspnea include:

Feeling short of breath
Dyspnea is the sensation of feeling short of breath.

A high ventilation/perfusion (V/Q) ratio can be caused by:

Obstruction to pulmonary blood flow
Obstruction to pulmonary blood flow results in decreased perfusion and a high V/Q ratio.

Respiratory failure is defined by which one of the following laboratory alterations?

High PaCO2
Respiratory failure results in CO2 retention and elevated PaCO2.

Lung injury that results in diffuse pulmonary inflammation and infiltrates and that is followed by development of a hyaline membrane at the alveolocapillary interface is a condition known as:

Acute respiratory distress syndrome (ARDS)
ARDS involves a lung-wide inflammatory response to direct or indirect lung injury and manifests with diffuse pulmonary infiltrates and the development of a hyaline membrane.

Non-cardiogenic pulmonary edema most often is caused by:

Systemic infection (sepsis)
Inflammation present with systemic infections and sepsis is the main cause of non-cardiogenic pulmonary edema (i.e., acute respiratory distress syndrom, or ARDS).

Pulmonary edema is an example of ________ pulmonary disease.

Restrictive
Pulmonary edema restricts alveolar or lung expansion.

Air that enters the pleural space during inspiration and is unable to exit during expiration creates a condition called:

Tension pneumothorax
A tension pneumothorax can collapse the lung because the pressure of the air in the pleural cavity exceeds the atmospheric pressure in the alveoli.

Which of the following characteristics is not typical of asthma?

Asthma causes alveolar collapse
The pathophysiology of asthma does not involve alveolar collapse.

A life-threatening complication of asthma is:

Status asthmaticus
Status asthmaticus is prolonged, severe bronchospasm that can be life-threatening if not reversed.

Airway obstruction in chronic bronchitis is generally the result of:

Thick mucus secretions and smooth muscle hyperplasia
Inspired irritants stimulate inflammation, mucus secretion, and bronchospasm, which can lead to smooth muscle thickening in the airways. All of these factors contribute to airway obstruction in chronic bronchitis.

Individuals who have recently developed chronic bronchitis often present with all of the following except:

a barrel chest
The symptoms that lead individuals with chronic bronchitis to seek medical care include decreased exercise tolerance, wheezing, shortness of breath and chronic productive cough.

The increased anterior-posterior chest diameter associated with obstructive lung disease is caused by:

Increased residual lung volumes
Increased residual lung volumes are a result of air trapping in obstructive lung disease and cause expansion of the chest wall.

Which of the following measures is most effective for preventing pulmonary emboli in patients who are recovering from major surgery?

Ambulate patients frequently to prevent blood clot formation
Venous stagnation, a major risk factor for deep vein thrombosis and pulmonary embolism formation, can be prevented by frequent ambulation after surgery.

Familial pulmonary hypertension usually is caused by:

a genetic mutation
Increased pulmonary vascular resistance from pulmonary emboli causes secondary pulmonary hypertension.

_______ is a term that signifies right-sided heart failure secondary to pulmonary hypertension.

Cor pulmonale
Cor pulmonale is right-sided heart failure secondary to pulmonary hypertension.

Alveolar edema in pneumococcal pneumonia is caused by:

Inflammatory cytokines
The infectious process in pneumococcal pneumonia results in the release of inflammatory mediators that cause alveolar edema.

________ atelectasis is the collapse of lung tissue caused by external pressure exerted by a tumor, fluid, or air.

Compression
Compression atelectasis occurs when a lung tumor, pulmonary edema, pleural effusion, or pneumothorax creates external pressures that collapse alveoli.

Pain on inspiration (pleuritic) is associated with which of the following disorders?

Pleural inflammation
Inflammation of the pleura often manifests with pain on inspiration, fever, and chills.

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