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 Pathophysiology Exam 2 Study Guide cx cx cx cx cx




Chapter 3o Respiratory Disorder cx cx cx




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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Thepressureinside the airways and alveoli of the lungs is called intrapulmonary(or alveolar) pressure;
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thepressurein the pleural cavity is called pleural pressure;
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andthe pressurein the thoraciccavity is called intrathoracic pressure.
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Thediaphragm is the principal muscle ofinspiration, assisted by the external intercostal muscles.
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Surfactant molecules, produced by type II alveolar cells, reduce the surface tension in the lungs and
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thereby increase lung compliance.
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** Lung volumes and lung capacities = reflect the amount of air that is exchanged during normal and
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forced breathing.
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KNOW: The tidal volume (VT) is the amount of air that moves into and out of the lungs during normal
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breathing.
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The respirator system consists of air passages and lungs, where gas exchange takes place. The air
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passagescan be divided into2 parts,the conducting airwaysthroughwhich air movesas it passesinto and
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out of the lungs, and the respiratory tissue where gas exchange actually takes place.
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• Respirationrequires ventilation,or the movement ofgases into and out ofthe lungs; perfusion, or
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movement of blood through the lungs; and diffusion of gases between the lungs and the blood.
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• Ventilation depends on the conductingairways, includingthe nasopharynx, oropharynx, larynx cx cx cx cx cx cx cx cx cx cx




and tracheobronchialtree, which move air into and outofthe lungsbutdo not participate in gas
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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 membrane as they are exchanged between the air in the lungs and the blood
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that flows through the pulmonary capillaries.
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• ConductingZone: cx c x Upper respiratorytract cx cx




• RespiratoryZone: Lower Airways cx cx cx




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




bronchioles. Conducting airways act as a conduit for airflowbut also warms, 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, dust and other foreign substances — this is in an upward motion that brings back to the
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oropharynx where it is expectorated or swallowed. cx cx cx cx cx cx




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




syncytial virus (RSV), human metapneumovirus (hMPV), coronaviruses, adenoviruses.
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• Pneumonia is the 8th leading cause of death in the US, especially in the elderly and those with
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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
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gas exchange or ventilation problems — in addition to other types of organisms such as bacteria
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and fungus which can cause lung infections. If patient has underlying history of asthma,
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this 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 —
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• ””Rhinovirus are the most common cause ofcolds. The common cold spreads easily, cx cx cx cx c x cx c x c x c x c x c x




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




disease, diabetes, etc)
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• Rhinosinusitis is inflammation involving nasal sinuses. The most common conditions are those cx cx cx cx cx c x cx cx cx cx cx




that obstruct the narrow ostia that drain the sinuses. Rhinosinusitis develops when a viral
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upper respiratory tract infection or allergic rhinitis causes mucosal swelling and obstructs the
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ostia and impairs the mucociliary clearance mechanism.
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• **The Mucociliary 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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• A M ucociliary 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
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S/S include facial pain, headache, purulent nasal discharge, diminished sense of smell and
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fever. **** Fever and facial pain are more commonly associated with rhinosinusitis rather
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than the common 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.
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People who are immunocompromised can present with fever of unknown origin, rhinorrhea
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or facial edema.
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• In chronic rhinosinusitis symptoms may consist of sinus pressure with nasal congestion. The
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patient may complain of headache that is dull and constant. Sinus headaches are exaggerated
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by 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 CT for cases of chronic 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. c x cx cx cx cx cx cx cx cx cx




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




• Influenza, combined with pneumonia, is the 8th leading cause of death in the US, and
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highest rates are in children and older adults. Transmission is not by contact but by
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inhalation of droplet nuclei. *The incubation period for influenza is 1-4 days with 2 days
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being the average. People become infectious starting 1 day before their symptoms begin and
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remain infectious 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,
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profuse 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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better 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. cx cx cx cx cx cx cx




• Viral pneumonia is a complication of the flu in older adults or people with cardiopulmonary
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disease but can be seen in pregnant women and health people as well. Viral pneumonia usually
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manifests within 1 day after onset of influenza and also has a rapid progression of symptoms, it
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progresses quickly and can cause hypoxemia and death within a few days of onset.
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c Survivors can develop diffuse pulmonary fibrosis.
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NRMS 5190 Advanced Pathophysiology Exam 2 Study Guide 2026/27 Update
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