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What is V/Q Ratio? What is a normal V/Q?
ANS 🗹🗹: axwrtVQ Ratio - To measure the efficiency of alveoli gas exchange:
V - Ventilation, air that reaches alveoli
Q - Perfusion, blood that reaches alveoli.
Normal - 5/4 - 0.8Lzz
Q: What is COPD?
ANS 🗹🗹: axwrtChronic Obstructive Pulmonary Disease. Irreversible decrease in the
ability to force air out of the lungs.zz
Q: What is emphysema?
ANS 🗹🗹: axwrtEmphysema is characterised by permanently enlarged/over-inflated air
spaces distal to terminal bronchioles.zz
Q: Emphysema results in three forms of airway remodelling, what are they?
ANS 🗹🗹: axwrt1. Alveolar wall breakdown - blebs
2. Bronchial wall fibrosis - narrow and weak airways
3. Difficulty with air expiration - air trappingzz
Q: What is the pathophys of emphysema (7 steps)
ANS 🗹🗹: axwrt1. Emphysema is characterised by permanently enlarged/over-inflated
air spaces distal to terminal bronchioles.
2. Irritants (tobacco) enter the lungs causing inflammation.
3. Alveolar macrophages phagocytose toxic particles and release cytokines to recruit
neutrophils, macrophages and lymphocytes
4. Neutrophils and macrophages release the protease enzyme elastase leading to
breakdown of elastin (elastic fibers in the alveolus).
5. Breakdown of elastic fibers leads to
a. Decrease recoil within alveoli.
b. Air trapping/bleb formation.
c. Lung overinflation - barrel chest
6. Thickening of bronchial walls leads to narrowed airways.
7. Loss of pulmonary tissue leads to decreased gas exchange and VQ usually matchedzz
Q: Advanced emphysema is characterised by four anatomical changed, what are they?
ANS 🗹🗹: axwrt1. Alveolar sacs form blebs/bullae
2. Pulmonary HTN
3. Change in respiratory drive - stimulated by O2 rather than CO2
4. Increased likelihood of pneumothorax due to ruptured pleural membranes/blebszz
Q: What are the classic emphysema pt presentation (6)?
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ANS 🗹🗹: axwrt1. pursed lip breathing - force air out and maintain PEEP
2. Constant SOB - puffing breathing
3. Barrel chest, loss of skeletal/fat and respiratory muscle fatigue
4. Pink - hypercapnia
5. Mild chronic cough
6. Diminished breath sounds on ausiltationzz
Q: How do you define chronic bronchitis?
ANS 🗹🗹: axwrtChronic productive cough for at least three consecutive months in at
least two consecutive years.
Its a excessive mucous issue.zz
Q: How do you define Chronic Bronchitis?
ANS 🗹🗹: axwrtPresence of a persistent productive cough for at least 3 consecutive
months in at least 2 consecutive years.zz
Q: What is the pathophys of Chronic Bronchitis (6 steps)?
ANS 🗹🗹: axwrt1. Chronic bronchitis is diagnosed based on clinical grounds. Defined by
the presence of a persistent productive cough for at least 3 consecutive months in at least
2 consecutive years.
2. Irritants enter lungs and causes T-cell mediated inflammatory response.
3. Hypertrophy and hyperplasia of goblet cells lead to excessive mucous production.
4. Inflammatory destruction of cilia leads to inability to clear secretions and mucous
pooling
5. Airway inflammation and mucous plugging results in
a. Outflow obstruction
b. Hypoxia and hypercapnia
c. Cyanosis
6. Excessive CO2 in blood causes
a. Respiratory acidosis
b. CO2 narcosis (confusion/drowsiness)
c. V/Q mismatch (low V/Q)zz
Q: What are the classic chronic bronchitis physiological changes (2)?
ANS 🗹🗹: axwrt1. Blue bloaters
2. Pulmonary vasoconstriction, leading to peripheral oedema, pulmonary HTN and cor
pulmonale.zz
Q: Explain the primary steps in COPD changing respiratory drive
ANS 🗹🗹: axwrt1. Healthy person, respiration rate and respiration stimulation is driven
by arterial concentrations of CO2.
What is V/Q Ratio? What is a normal V/Q?
ANS 🗹🗹: axwrtVQ Ratio - To measure the efficiency of alveoli gas exchange:
V - Ventilation, air that reaches alveoli
Q - Perfusion, blood that reaches alveoli.
Normal - 5/4 - 0.8Lzz
Q: What is COPD?
ANS 🗹🗹: axwrtChronic Obstructive Pulmonary Disease. Irreversible decrease in the
ability to force air out of the lungs.zz
Q: What is emphysema?
ANS 🗹🗹: axwrtEmphysema is characterised by permanently enlarged/over-inflated air
spaces distal to terminal bronchioles.zz
Q: Emphysema results in three forms of airway remodelling, what are they?
ANS 🗹🗹: axwrt1. Alveolar wall breakdown - blebs
2. Bronchial wall fibrosis - narrow and weak airways
3. Difficulty with air expiration - air trappingzz
Q: What is the pathophys of emphysema (7 steps)
ANS 🗹🗹: axwrt1. Emphysema is characterised by permanently enlarged/over-inflated
air spaces distal to terminal bronchioles.
2. Irritants (tobacco) enter the lungs causing inflammation.
3. Alveolar macrophages phagocytose toxic particles and release cytokines to recruit
neutrophils, macrophages and lymphocytes
4. Neutrophils and macrophages release the protease enzyme elastase leading to
breakdown of elastin (elastic fibers in the alveolus).
5. Breakdown of elastic fibers leads to
a. Decrease recoil within alveoli.
b. Air trapping/bleb formation.
c. Lung overinflation - barrel chest
6. Thickening of bronchial walls leads to narrowed airways.
7. Loss of pulmonary tissue leads to decreased gas exchange and VQ usually matchedzz
Q: Advanced emphysema is characterised by four anatomical changed, what are they?
ANS 🗹🗹: axwrt1. Alveolar sacs form blebs/bullae
2. Pulmonary HTN
3. Change in respiratory drive - stimulated by O2 rather than CO2
4. Increased likelihood of pneumothorax due to ruptured pleural membranes/blebszz
Q: What are the classic emphysema pt presentation (6)?
, Page | 2
ANS 🗹🗹: axwrt1. pursed lip breathing - force air out and maintain PEEP
2. Constant SOB - puffing breathing
3. Barrel chest, loss of skeletal/fat and respiratory muscle fatigue
4. Pink - hypercapnia
5. Mild chronic cough
6. Diminished breath sounds on ausiltationzz
Q: How do you define chronic bronchitis?
ANS 🗹🗹: axwrtChronic productive cough for at least three consecutive months in at
least two consecutive years.
Its a excessive mucous issue.zz
Q: How do you define Chronic Bronchitis?
ANS 🗹🗹: axwrtPresence of a persistent productive cough for at least 3 consecutive
months in at least 2 consecutive years.zz
Q: What is the pathophys of Chronic Bronchitis (6 steps)?
ANS 🗹🗹: axwrt1. Chronic bronchitis is diagnosed based on clinical grounds. Defined by
the presence of a persistent productive cough for at least 3 consecutive months in at least
2 consecutive years.
2. Irritants enter lungs and causes T-cell mediated inflammatory response.
3. Hypertrophy and hyperplasia of goblet cells lead to excessive mucous production.
4. Inflammatory destruction of cilia leads to inability to clear secretions and mucous
pooling
5. Airway inflammation and mucous plugging results in
a. Outflow obstruction
b. Hypoxia and hypercapnia
c. Cyanosis
6. Excessive CO2 in blood causes
a. Respiratory acidosis
b. CO2 narcosis (confusion/drowsiness)
c. V/Q mismatch (low V/Q)zz
Q: What are the classic chronic bronchitis physiological changes (2)?
ANS 🗹🗹: axwrt1. Blue bloaters
2. Pulmonary vasoconstriction, leading to peripheral oedema, pulmonary HTN and cor
pulmonale.zz
Q: Explain the primary steps in COPD changing respiratory drive
ANS 🗹🗹: axwrt1. Healthy person, respiration rate and respiration stimulation is driven
by arterial concentrations of CO2.
