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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
What is one hallmark sign of peripheral arterial disease? Intermittent claudication (cramping sensation in calves) What are some changes to the skin associated with peripheral arterial disease?
- Pallor
- Shiny skin
- Hair loss
- Arterial ulcers
- Poor healing Why should a PT be cautious of coronary artery disease if a patient has peripheral arterial disease? Similar arterial changes may be happening in the coronary arteries, patient may not be symptomatic without exertion Is peripheral arterial disease usually unilateral or bilateral? Bilateral What is a common method used to assess blood flow to the extremities in patients with peripheral arterial disease? Ankle-brachial index
What are some considerations for integumentary assessments on patients with peripheral arterial disease?
- Symmetry
- Proximal/distal presentation
- Changes in skin tone (consider visibility differences with different skin tones)
- Wound presence/healing What are some causes for venous insufficiency?
- Incompetent valves
- 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
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) What are normal values for an arterial blood gas test? pH - 7.35-7. PaCO2 - 35 - 45 mmHg PaO2 - >80 mmHg HCO3 - 21 - 28 mEq/L What are normal values for a venous blood gas test? pH - 7.31-7. PaCO2 - 40 - 50 mmHg PaO2 - 40 - 50 mmHg
Conducting and respiratory zones 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
Passive process in which the diaphragm relaxes and air is pushed out of the airways Exhalation Describe the mechanics of pressure in breathing Inhalation increase intrathoracic volume, lowering pressure and allowing atmospheric air to flow into the lungs. Exhalation decreases intrathoracic volume, raising pressure and allowing air to exit the lungs. Describe the significance of compliance in the mechanics of ventilation The lungs, diaphragm, and other thoracic cavity structures must be able to deform to allow for easy inhalation Describe the significance of elasticity in the mechanics of ventilation The lungs, diaphragm, and other thoracic cavity structures must be able to return to their original form to assist with exhalation Describe the significance of surface tension in the mechanics of ventilation Surfactant is a substance produced in the lungs that lowers surface tension in the alveoli. This process prevents alveolar collapse and aids in gas exchange.
Describe the significance of airway resistance in the mechanics of ventilation Increased resistance corresponds with an increased workload on the ventilatory pump system. Airways radius is the most crucial factor. What is the equation for airway resistance? R aw = 8nl/πr^ n = viscosity of the air l = length of the airway r = radius of the airway What is the equation for minute ventilation? Ve = tidal volume x respiratory rate (amount of air per breath x number of breaths per minute) 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
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?
=75-80% What is a typical FEV1 value for healthy adults? =75-80% of FVC
- Abnormal trachea position (pulmonary edema/effusion could move trachea to one side) What is the purpose of a V/Q scan? 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
