NRMS 5190 Advanced Pathophysiology Exam 2 Study Guide | 2026/27 Update with complete solutions - SUNY Downstate Medical Center.

NRMS 5190
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Advanced PathophysiologyExam 2 StudyGuide v5 5
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Chapter 3o Respiratory Disorder v 5 v5 v5




The movement of air between the atmosphere and the lungs follows the laws of physics as they relate to
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gases. The air in the alveoli contains a mixture of gases, including nitrogen, oxygen, carbon dioxide, and
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water vapor..
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Thepressureinsidetheairwaysand alveoli ofthelungsiscalled intrapulmonary(oralveolar) pressure;
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thepressureinthepleural cavityiscalled pleuralpressure;
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andthepressureinthethoraciccavityiscalled intrathoracicpressure.
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Thediaphragmistheprincipal muscleofinspiration, assisted bytheexternal intercostal muscles.
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Surfactant molecules, produced bytype II alveolarcells, reducethe surface tension in the lungs and thereby
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increase lung compliance.
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** Lungvolumes and lungcapacities = reflect the amount ofair that is exchanged duringnormal and forced
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breathing.
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KNOW: The tidal volume (VT) is the amount ofair that moves into and out ofthe lungs duringnormal
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breathing.
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The respiratorsystem consists ofair passages and lungs, where gas exchange takes place. The air
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passagescanbedividedinto2parts,theconductingairwaysthroughwhichairmovesasitpassesinto and out
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ofthe lungs, and the respiratorytissue where gas exchange actually takes place.
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• Respirationrequiresventilation,orthemovementofgasesintoandoutofthelungs; perfusion, or v5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v 5 v5 v5




movement ofblood through the lungs; and diffusion ofgases between the lungs and the blood.
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• Ventilation dependson theconductingairways, includingthenasopharynx, oropharynx, larynx and v5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v5




tracheobronchialtree,whichmoveairintoandoutofthelungsbutdonotparticipateingas exchange,
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• Gas exchange takes place in the respiratory airways of the lungs where gases diffuse across the
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alveolar-capillary membraneas theyare exchanged between the airin the lungs and theblood that
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flows through the pulmonary capillaries.
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• ConductingZone: Upperrespiratorytract v5 v 5 v5 v5




• RespiratoryZone: LowerAirways v5 v5 v5




• Conducting airways: nasal passages, mouth, pharynx, larynx, trachea, bronchi and v5 v5 v5 v5 v5 v5 v5 v5 v5




bronchioles. Conducting airways act as a conduit forairflowbut alsowarms, filters and
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humidifies air as it moves through these structures.
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KNOW *The conducting airways are lined with a mucociliary blanket — a protective layer
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with
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mucous and cilia (cells with hairlike projections that help sweep and trap particles such as
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bacteria, dustand otherforeign substances —this isinan upward motion that brings backtothe
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oropharynx where it is expectorated or swallowed. v5 v5 v5 v5 v5 v5




• ** Lung volumes and lung capacities reflect the amount of air that is exchanged during normal and
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forced breathing. The tidal volume (VT) is the amount of air that moves into and out of the lungs
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during normal breathing.
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• Common Cold- viral infection ofthe upper respiratory tract. Adults can have 3-4per year,
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school age child may have 6-8 per year.
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• **Rhinovirus are most common causefor cold, others are parainfluenza virus, respiratory v5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v5




syncytial virus (RSV), human metapneumovirus (hMPV), coronaviruses, adenoviruses.
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• Pneumonia is the 8th leading cause ofdeath in the US, especially in the elderly and those with v5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v5




compromised immune function.
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• TB affects 1/3 of the world's population.
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• People who have compromised immune systems may be susceptible to a virus causing serious gas
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exchange or ventilation problems —in addition to other types oforganisms such as bacteria and
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vfungus which can cause lung infections. If patient has underlying history of asthma, this
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may be exacerbated by presence of a virus
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• Viral infections can damage bronchial epithelium, obstruct airways and lead to secondary
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bacterial infections.
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• Common cold is an acute and self limiting illness in otherwise healthy people — v 5 v 5 v5 v 5 v5 v 5 v5 v5 v5 v 5 v5 v5 v5




• ””Rhinovirus are the most common cause ofcolds. The common cold spreads easily, v5 v5 v5 v5 v 5 v5 v 5 v 5 v 5 v 5 v 5




handwashing is very important because fingers are the greatest source of spread and the nasal
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vmucosa and conjunctival surface of eyes are most common portal of entry for virus. Symptoms
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begin with dryness and stuffiness in the nasopharynx, followed by excessive production of nasal
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secretions and tearing of the eyes. Secretions are usually clear and watery. Other symptoms —
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erythema and swelling of mucous membranes of upper respiratory tract , postnasal drip, sore
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throat, hoarseness, headaches and generalized malaise. Fevers chills and exhaustion
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vcan be seen in severe cases. Treatment is rest, OTCs (decongestants can cause systemic
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vasoconstriction and elevation of BP so should be avoided in people with yTT,, heart disease, v 5 v 5 v 5 v 5 v5 v5 v 5 v5 v 5 v 5 v5 v5 v 5 v5




diabetes, etc)
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• Rhinosinusitis is inflammation involving nasal sinuses. The most common conditions are those v5 v5 v5 v5 v5 v 5 v5 v5 v5 v5 v5




that obstruct the narrow ostia that drain the sinuses. Rhinosinusitis develops when a viral upper
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respiratory tract infection or allergic rhinitis causes mucosal swelling and obstructs the ostia and
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impairs the mucociliary clearance mechanism.
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• **The Mucociliary clearance mechanism helps keep the sinuses sterile bymoving fluid and
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microorganisms out of the sinuses and into the nasal cavity.
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• AMucociliary clearance mechanism helps keep the sinuses sterile by moving fluid and
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microorganisms out of the sinuses and into the nasal cavity.
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• Viral rhinosinusitis can be difficult to differentiate from common cold and allergic rhinitis. The S/S
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include facial pain, headache, purulent nasal discharge, diminished sense of smell and fever. ****
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Fever and facial pain are more commonly associated with rhinosinusitis rather than the common
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cold. Symptoms usually resolve in 5-7 days without medical treatment.
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• Bacterial rhinosinusitis — the symptoms that worsen after 5-7 days or persist beyond 10 days. v5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v5




People who are immunocompromised can present with fever of unknown origin, rhinorrhea or
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facial edema.
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• In chronic rhinosinusitis symptoms may consist of sinus pressure with nasal congestion. The
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patient maycomplain ofheadache that is dull and constant. Sinus headaches are exaggerated by
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bending forward, coughing or sneezing. The epithelial changes that occur during acute
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rhinosinusitis are usually reversible but the mucosal changes that occur with chronic
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rhinosinusitis are often irreversible.
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• Pt may need CTfor cases ofchronic rhinosinusitis to make sure there are no polyps or
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deformities that could be causing obstruction of drainage.
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• Treatments: 2/3rds of cases of acute bacterial rhinosinusitis improve without antibiotics. Most v 5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v5




people with viral sinusitis improve within a week. Some people require antibiotics which can
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be 3-4weeks, theymayneed nasal irrigation and intranasal, decongestants (should be limited 3-5
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days to prevent rebound vasodilation) - Saline spray, mist humidification.
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• Mucosal changes are not permanent. v 5 v5 v5 v5




• Influenza, combined with pneumonia, is the 8th leading cause of death in the US, and highest v 5 v 5 v 5 v 5 v5 v5 v5 v5 v5 v5 v 5 v 5 v5 v 5 v 5




rates are in children and older adults. Transmission is not by contact but by inhalation
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vof droplet nuclei. *The incubation period for influenza is 1-4 days with 2 days being the
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average. People become infectious starting 1 day before their symptoms begin and remain infectious
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for about 1 week after illness onset.
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• Influenza starts with abrupt onset of fevers and chills, rigors, malaise, muscle aches, headaches, v5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v5 v5




vprofuse watery nasal discharge, nonproductive cough and sore throat. The rapid onset of
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profound malaise is a distinguishing feature of an influenza infection. Secondary
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complications are pneumonia, sinusitis, otitis media, bronchitis, bacterial pneumonia, croup in
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children. People with secondary bacterial pneumonia may say that they began to feel
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vbetter but they experienced a return of fever, chills, pleuritic chest pain and productive
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cough
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• Influenza C is more like the common cold. v 5 v5 v5 v5 v5 v5 v 5




• Viral pneumonia is a complication of the flu in older adults or people with cardiopulmonary disease
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but can be seen in pregnant women and health people as well. Viral pneumonia usually manifests
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within 1 day after onset of influenza and also has a rapid progression of symptoms, it progresses
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vquickly and can cause hypoxemia and death within a few days of onset. Survivors can
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develop diffuse pulmonary fibrosis.
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