Download 2025-2026 NIGHTINGALE PATHOPHYSIOLOGY FINAL EXAM|ACTUAL 300+Qs&As|ALREADY GRADED A+ and more Exams Pathophysiology in PDF only on Docsity!
2025 - 2026 NIGHTINGALE PATHOPHYSIOLOGY
FINAL EXAM|ACTUAL 300+Qs&As|ALREADY
GRADED A+
A patient has normal breathing when they lay down initially, but experience shortness of breath after sleeping for a few hours. Their condition is associated with early-stage heart failure. Which condition does the patient have? Paroxysmal Noctural Dyspnea A patient has experiences shortness of breath immediately in supine, expressing that they "can't lay flat". They sleep in a recliner at night with their head elevated. Their condition is associated with late-stage heart failure. Which condition does the patient have? Orthopnea Which conditions contribute to presentation of symptoms with decompensated heart failure?
- Disease state/progression
- Exertion
- Body position Describe the concept of heart failure compensation Heart failure causes low blood pressure, signaling for compensatory sympathetic stimulation. Over time, adverse structural changes can occur because of chronic compensation. What are some common drugs used to treat chronic heart failure?
- Lasix (diuretic, decreases fluid to combat RAAS response)
- Angiotensin converting enzyme (ACE) Inhibitors/Angiotensin Receptor Blockers (ARBs) (vasodilation)
- Beta blockers (reduces sympathetic stimulation)
- Cardiac Glycosides/Digoxin (positive ionotropes, potentially toxic with "low therapeutic index")
- Positive inotropes (increases contractility)
Cardiac condition mainly treated with a heart transplant, progression is difficult to stop once it begins. Heart contraction and relaxation is impaired. Can be dilated, hypertrophic, restrictive, and ischemic Cardiomyopathy Cardiomyopathy in which heart enlarges and abnormal filling causes diastolic dysfunction. Thickening of left ventricle wall and sudden death in young people are common with this condition. Hypertrophic cardiomyopathy Cardiomyopathy in which altered cardiac muscle tone causes enlargement of all chambers of the heart. Increased filling and systolic dysfunction are common. Most common type of cardiomyopathy. Dilated cardiomyopathy Cardiomyopathy in which rigid ventricular walls cause impaired filling but normal pumping. Diastolic function is impaired, least common type of cardiomyopathy. Restrictive cardiomyopathy Abnormalities in which body functions can lead to exercise intolerance with heart failure?
- Ventilation/gas exchange
- Stroke volume
- Heart rate
- Skeletal muscle metabolism How can end-stage heart failure be medically managed?
- Intra-aortic balloon pump
- Ventricular assist devices
- Heart transplant Obstruction of large or medium-sized arteries
- Venous thrombus
- Impaired venous tone
- Muscle pump dysfunction
- Heart failure What are expected changes to the skin with venous insufficiency?
- Dependent LE edema
- Skin discoloration
- Stasis ulcers
- Poor healing Integumentary condition with inflammation and hardening of adipose tissue and skin, skin discoloration is common Lipodermatosclerosis What are the three main components of Virchow's triad?
- Endothelial damage (cardiac cell damage)
- Hypercoagulability (increased blood thickness)
- Stasis (blood stays still) Is a deep vein thrombosis more commonly seen bilaterally or unilaterally? Unilaterally What are some signs, symptoms, and tests that can help identify a DVT? 1 ) Localized inflammation (redness, warmth, swelling)
- Localized pain near thrombus
- Elevated D-Dimer (clot breakdown in blood)
- Venous Doppler (visualizing blood flow through veins) Explain how a DVT can become a pulmonary embolism A venous thrombus can travel back through larger vessels to the right side of the heart, where it is pumped to the smaller vessels in the lungs and causes a blockage.
How can a DVT be medically managed?
- Anticoagulants (ex. heparin and coumadin)
- Greenfield Filter (catches and dissolves clot before entering heart)
- Thrombolysis (invasive removal of thrombus) The Wells Criteria for the Prediction of Deep Vein Thrombus analyzes a patient's risk for having a DVT. Which cutoff determines whether a patient is likely or unlikely to have a DVT?
2 is likely to have a DVT <2 is unlikely to have a DVT What are some measures of coagulation?
- Thrombin Time (TT)
- Partial Thromboplastin Time (PTT)
- Activated Partial Thromboplastin time (aPTT) 4International Normalized Ratio (INR) Which three systems make up the oxygen transport system?
- Ventilatory Pump System
- Cardiovascular Pump System
- Neuromuscular System What are possible structures that can affect the ventilatory pump system?
- Bony structures of the thorax (ribs, sternum, thoracic vertebrae)
- Lungs
- Airways
- Respiratory muscles (diaphragm, accessory muscles)
- Nervous system (phrenic nerve C3, 4, 5) What are the main functions of the ventilatory pump system?
- Ventilation (air movement)
- Respiration (gas exchange)
- Protection (maintaining airway integrity)
Which structures are included in the conducting zone of the lower airways? Trachea, bronchi, and bronchioles Which structures are included in the respiratory zones of the lower airways? Respiratory bronchioles and alveoli List the factors that impact passive diffusion in alveoli during respiration?
- Partial pressures
- Surface area - shape and number of alveoli
- Membrane permeability - single layer of endothelial cells
- Time Ratio of ventilation (V) and perfusion (Q) in alveoli measuring respiratory function, optimal functioning when V=Q V-Q Ratio Describe how the V-Q ratio changes with a right-to-left cardiac shunt Deoxygenated blood enters the left ventricle and decreases ventilation, making Q>V Describe how the V-Q ratio changes with increased pulmonary dead space A lower portion of inhaled air is involved in gas exchange, making V>Q Regions within the airways where gas exchange is not occurring due to lower alveolar perfusion Dead Space Fixed volume of air with no potential for gas exchange due to the absence of alveoli in a region. Normal finding in patients. Anatomical Dead Space
Dynamic volume of air in which gas exchange is not occurring due to decreased alveoli usage. Normal finding in patients temporarily, but can be pathologic if it becomes fixed. Physiologic Dead Space What are some factors that may alter physiologic dead space? Depth of inspiration and cardiopulmonary system workload List the main ventilatory muscles
- Diaphragm
- Sternocleidomastoid
- Scalenes (anterior, middle, posterior)
- Abdominal muscle What is the innervation of the diaphragm? Phrenic nerve (C3, 4, 5) What is the innervation of the sternocleidomastoid? Spinal accessory nerve (CN XI) Which spinal cord segments are associated with the scalenes? C4- 8 Which spinal cord segments are associated with the abdominals? T5-L Active process in which the diaphragm contracts and air is drawn into airways Inhalation Passive process in which the diaphragm relaxes and air is pushed out of the airways Exhalation
What is the equation for maximal voluntary ventilation? MVV = maximum tidal volume x maximum respiratory rate Maximal amount of air that an individual can exhale from their lungs following a maximal inhalation Vital capacity Total amount of air in the lungs after a maximal inhalation Total lung capacity Maximal amount of air that an individual can forcefully inhale into their lungs after a resting exhale Inspiratory capacity Maximal amount of air that an individual can forcefully inhale after a resting inhale Inspiratory reserve volume Volume from resting inhalation to resting exhalation Tidal volume Maximal amount of air that an individual can forcefully exhale after a resting exhalation Expiratory reserve volume Remaining volume in lungs after a maximal exhalation Residual volume What is the clinical significance of residual volume in the lung?
Some volume in the lung after exhalation allows for an optimal length-tension relationship in diaphragmatic contraction Test to measure changes in lung and thoracic cavity size during breathing Plethysmography Lung volume ranging from a maximal inhalation to a maximal exhalation Forced vital capacity Volume of air that can be forcefully expired in one second FEV Volume of air released during the middle portion of an exhalation (25-75% of expiratory volume) Mid-Expiratory Flow Rate Highest volume of air expired during a forced exhalation Peak Expiratory Flow What is the clinical significance of the FEV1/FVC ratio? Indicated the ability to quickly and forcefully exhale relative to total expiratory volume Which portion of an individual's airway is emptied during an FEV1 assessment? Upper airways Which portion of an individual's airway is emptied during a forced vital capacity assessment after one second? Lower airways What is a typical FEV1/FVC ratio value for healthy adults?
Assessing ventilation and perfusion capacities to analyze function and matching (ex. v>q with a pulmonary embolism) What is the purpose of a bronchoscopy Visualize and potentially remove pathologic tissue from bronchi What is the purpose of a measure of diffusion (DLco) test? Administration of a controlled amount of carbon monoxide typically leads to quick diffusion. Slow diffusion can indicate pathology What is the purpose of administering the methacholine challenge? A substance is administered to test for a reactive airway. Bronchoconstriction in patients indicates the presence of asthma. What is the purpose of collecting sputum cultures? Identify a potential respiratory infection What are some risk factors for pulmonary diesease?
- Smoking history
- Environmental exposure
- Premature birth
- Age
- Genetics What is the primary limitation of obstructive lung dysfunction (OLD)? Expiratory capacity or getting air out Which value for FEV1/FVC ratio would indicate the presence of an obstructive lung dysfunction? FEV1/FVC < 80%
What are some pathophysiologic characteristics of an individual with obstructive lung disease?
- Decreased expiratory markers (FEV1, FVC, FEF)
- Increased RV (and RV/TLC ratio)
- Increased mucus production
- Chronic productive cough
- Hypoxemia nad hypercapnea
- Cor pulmonale (secondary pulmonary hypertension causing right-sided heart failure) What are some clinical characteristics of an individual with obstructive lung disease?
- Impaired ventilation, respiration, and airway protection
- Tachypnea (increased RR)
- Flattened diaphragm ("barrel-chested")
- Dyspnea/SOB (increased work of breathing)
- Usage of accessory muscles of breathing and "tripod" position for recovery (bent over with hands on knees/thighs, increases effectiveness of accessory muscles)
- Breathing through pursed lips (increases exhalation time)
- Postural and musculoskeletal dysfunction
- Nutritional depletion (increased metabolic work through labored breathing, difficulty eating) Heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum production and/or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction. Chronic obstructive pulmonary disease (COPD) What is one reason that COPD is often underdiagnosed? Only 5% of one's lung capacity is used at rest, symptoms may not present if an individual does not utilize their full lung capacity through activity Where does COPD rank in the overall causes of death? 3rd worldwide, 5th in the USA
Stage II/Moderate A patient has an FEV1 value of 30-49% and an FEV1/FVC ratio of <70%. Using GOLD stages, what classification of COPD severity should this patient receive? Stage III/Severe A patient has an FEV1 value of <30% and an FEV1/FVC ratio of <70%. Using GOLD stages, what classification of COPD severity should this patient receive? Stage IV/Severe What is the significance of an FEV1/FVC ratio value of less than 70%? Aligns with an obstructive lung dysfunction Describe the significance of asthma being a "reactive airways disease". Patients only experience respiratory issues during a flare up, airway obstruction is not constant Describe the significance of asthma being a "reversible obstruction". Administering beta-2 agonists can increase bronchodilation and improve spirometry values What are some potential triggers that could invoke asthma symptoms?
- Infection
- Allergens
- Physiologic stress (exercise/exertion)
- Psychologic stress (fear, anxiety, etc.) Describe the pathogenesis of asthma
- Exposure to trigger
- Airway inflammation
- Increased mucus production, airway muscle tightening, and bronchial membrane swelling
- Narrow breathing passages
- Wheezing, coughing, SOB What is the prevalence of exercise-induced bronchoconstriction? 5 - 20% of general population, 90% of symptomatic individuals with asthma A physical therapist is prescribing aerobic exercise for an individual who has asthma and is symptomatic. How can they alter their prescription to avoid exercise-induced bronchoconstriction? Encourage an individual to take a bronchodilator before exercise and incorporate an appropriate warm-up to gradually increase activity to the desired level. Should aerobic exercise be avoided for individuals with asthma? No! Appropriately-dosed aerobic exercise is important to reduce symptoms and desensitize airways (preventing intensity/frequency of flare ups) What is a common demographic for individuals with cystic fibrosis? White adults Describe the significance of cystic fibrosis being a genetic autosomal recessive disorder. Both parents must at least be a carrier of the gene for a child to be born with cystic fibrosis. What are some methods that are used to diagnose cystic fibrosis?
- Genetic testing
- Sweat chloride levels
- Clinical presentation How does the CF transmembrance regulator (CFTR) change in patients with cystic fibrosis?
What are some ways that obstructive lung dysfunction can be medically managed?
- Non-pharmacological (lifestyle changes and pulmonary rehab)
- Pharmacological agents (mucolytics, bronchodilators, corticosteroids, antibiotics, O2 therapy)
- Surgical options (lobectomy/transplant)
- Hospice and palliative care (end of life/symptom management) Describe the mechanics of restrictive lung dysfunction Decreased ability to get air into lungs decreases lung volume and capacity. Ratios remain the same as healthy individuals, individuals often compensate through increased respiratory rate What are some pathophysiologic characteristics of individuals with restrictive lung dysfunction?
- Decreased lung volumes and capacities grossly
- Normal FEV1/FVC ratio
- Mucus retention via impaired ventilation (normal levels and decreased explusion)
- Non-productive cough
- Hypoxemia and hypercapnia
- Cor pulmonale (secondary pulmonary hypertension causes right-sided heart failure) What are some clinical characteristics of individuals with restrictive lung dysfunction?
- Impaired ventilation and airway protection
- Tachypnea
- Increased work of breathing causing dyspnea/SOB
- Accessory muscle use
- Pursed lip breathing
- Tripod position
- Postural and musculoskeletal dysfunction
- Nutritional depletion
A patient with restrictive lung disease receives spirometry testing. What are the expected findings? Normal FEV1/FVC ratios, significant decreased in %predicted for FEV1 and FVC values What is the clinical significance of grossly reduced volumes and capacities in individuals with restrictive lung dysfunction? Symptoms may not present at rest, but exertion will produce symptoms. Patients may not be able to increase depth/volume of breathing, so a premature increased respiratory is common. Condition in premature infants with surfactant deficiency, causing alveolar stiffness and decreased respiration Respiratory distress syndrome (RDS) Condition in adults with surfactant deficiency, causing alveolar stiffness and decreased respiration Adult Respiratory Distress Syndrome (ARDS) Which radiographic changes are evident to identify children with respiratory distress syndrome (RDS)? Abnormal white shade in lungs and visualization of tracheobronchial tree Describe the significance of the hyaline membrane in adult respiratory distress syndrome. Hyaline membranes in alveoli are normal for healing, but cause pulmonary edema if they are chronically overactive Describe the significance of PaO2/FiO2 ratio to classify respiratory failure. Assesses the concentration of oxygen in arteries relative to the fraction of inspired oxygen.
- Normal PaO2 is 80-100 mmHg
- Normal FiO2 is 21%
