NR507 Week 4 Midterm Exam
I I I I
Pulmonary
1. Concepts Iof Ianticholinergic Idrug Iand Iasthma:
Anticholinergic Idrugs: Iblock Iacetylcholine Ibinding I(primarily Iin Ithe Ilungs) I-promotes Ibronchiole
Idilation Ithrough Idecrease Iin Ithe Iparasympathetic Iresponse I(tiotropium I& Iipratropium) Iis Ifast
Iacting
2. Bronchitis I& Iassociated Ipathogenesis:
Begins Iwith Ian Iexposure Ito Ian Iirritant I(tobacco Ismoke) I– Iactivates Ibronchiole Ismooth Imuscle
Iconstriction- Imucus Isecretion- Irelease Iof Iinflammatory Imediators(histamine, Iprostaglandins I&
Ileukotrienes) Inormal Iresponse Ito Ioccasional Iairborne Isite Iirritants- Iover Ibronchitis Iis Iover Ilong
Iterm I3 Imonths Ifor Iover I2 Iconsecutive Iyears- I= Ismooth Imuscle Ihypertrophy I= Iincrease
Ibronchoconstriction, Ihypertrophy Iand Ihyperplasia Iof Igoblet Icells= Imucus Ihypersecretion,
Iepithelia Icell Imetaplasia I= Inon-ciliated Isquamous Icells, Imigration Iof Imore IWBCs Ito Isite I=
Iinflammation Iand Ifibrosis Iin Ibronchial Iwall, Ithickening Iand Irigidity Iof Ibronchial Ibasement
Imembrane= Inarrowing Iof Ibronchial Ipassageways I: IIncreased Imucus Iproduction- Iinflammation
Iprocess I= Iweight Iloss, Iloss Iof Iappetite, Imuscle Iweakness I(interleukin Icontrols Iappetite)
Iincreases Iprotease Iactivity= Ibreakdown Iof Ielastin Iin Ithe Iconnective Itissues Iof Ithe Ilung=
Idestruction Iof Ithe Iwall Ibetween Ithe Ialveoli Iand Ilungs I= Ilarge Iineffective Iair Isacs Idevelop-elastic
Irecoil Iof Ibronchial Iwall I-destroys Ibronchi Iand Icant Idilate Iand Ithey Istay Iconstricted I=air Itrapping
I: IChronic Ibronchitis
=Dyspnea- Iair Itrapping Iincreased Imucus, Iincrease IWOB Ir/t Ichronic Ibronchoconstriction
ICough- Iirritated Iand Iinflamed Ibronchial Iepithelia Imembrane IHypoxia I& IHypercapnia I-
fromIimpaired Igas Iexchange
3. Chronic Ibronchitis Iand Irelated Iacid/base Idisturbance:
Hypercapnia I(CO2 Iretention) I= IRespiratory Iacidosis
r/t Ianatomical Ichanges Iventilation Iis Icompromised Iesp. Iexhalation I= Ialveolar Ihyperinflation)
Iexpanded Ithorax) Ihypercapnia ICO2 Iretention I= Irespiratory Iacidosis\
4. Perfusion:
the Iactual Iexchange Iof IO2 Iand ICO2 Iin Ithe Ibloodstream Ioccurs Ivia Ithe Ialveoli Iand Ipulmonary
Icapillaries: Ithe Ipassage Iof Ifluid Ito Ian Iorgan Ior Ia Itissue Iusually Ireferring Ito Idelivery Iof Iblood Ito Ian
Iarea
5. Blood Iflow Ibetween Ithe Iheart Iand Ilungs Iin Ichronic Ibronchitis:
Poor Iventilation Ileads Ito Ir Ito Il Ishunting Ito Ioccur= Ideoxygenated Iblood Ipasses Ifrom Ir Iventricle Ito
Ithe Ilungs Ito Ithe Il Iventricle Iwithout Iadequate Iperfusion I(gas Iexchange) Ithe Ikidneys Irespond Iby
Isecreting Ierythropoietin Iincreasing IRBC Iproduction Ithe Iincrease Iin IRBC Iincrease IO2 Icarrying
Icapacity I-the Iincrease Iblood Ivolume Iincreases Ithe Iworkload Iof Ithe Ipulmonary Iand
IcardiovascularIsystems Iincreasing Iblood Ivolume Iand Ivasoconstriction I= Ipulmonary IHTN=
Iincrease Iworkload IonIthe IR Iventricle I=cardiac Ihypertrophy= IR Iside IHF Ior ICor IPulmonale
6. Asthma Isigns Iand Isymptoms:
Coughing Iesp. Iat Inight, Ichest Itightness, Ishortness Iof Ibreath, Iwheezing Ion Iexhalation, Iand Irapid
Ibreathing: ICharacteristics: Iairway Iinflammation, Ibronchial Ihyperactivity, Ismooth Imuscle Ispasms, I=
, excessive Imucus Iproduction, Ihypertrophy Iof Ibronchial Ismooth Imuscle I-obstruction Iand Idecrease
Ialveolar Iventilation
7. Bronchioles Iin Iasthma:
There Iare I3 Ilayers Iof Ithe Ibronchiole Iwhich Iis Ia Itube-like Istructure Isurrounding Ithe Ilumen Ior Iairway
Ipassageway: Iinnermost Ilayer Iis Icomposed Iof Icolumnar Iepithelial Icells Iand Igoblet Icells-
The Ioutermost Ilayer Iis Icomposed Iof Ismooth Imuscle Icells Iresponsible Ifor Ithe Iability Iof Ithe Iairway
Ito Iconstrict Iand Idilate I– Ithe Imiddle Ilayer Iis Ithe Ilaminar Ipropria Iand Iit Iis Iembedded Iwith
IconnectiveItissue Iand Iimmune Icells: Iin Iasthma Ithese Iprotective Ifeatures Igo Ioveractive
I=inflammation Iresponse= Idamage Ito Ihost Itissue=hypertrophy Iof Ithe Ibronchioles Ismooth Imuscle
Iand Iexcessive Imucus Iproduction: Ibronchioles Ispasm-mucus Iproduction-obstruction
8. Alveolar Ihyperinflation Iwith Iasthma:
Increase Imucus Iproduction Ifrom Ithe Igoblet Icells Iin Ithe Iinflammation Iprocess Iforms Iplugs Iof Imucus
Iand Ipus Iand Iblock Ialveolar Ipassageways Ileading Ito Iair Itrapping Iand Ihyperinflation I= Ierosion Iof
Iairway Itissue
9. Polycythemia IVera:
a Irare Iblood Idisease Iin Iwhich Ithe Ibody Imakes Itoo Imany IRBCs Imaking Ithe Iblood Ithicker Ithan
Inormal Icausing Iblood Iclots; Iis Ioften Ia Iresult Iof Ichronic Ilow Ilevels Iof IO2 Iin Ithe Iblood, Ithe Ikidney
Icompensates Iby Iincrease Isecretion Iof Ierythropoetin, Ithe Iprimary Ihormone Iresponsible Ifor
Istimulating IRBC Iproduction= Ias Ia Iresult Ipatients Iwith Ichronic Ibronchitis Iwill Ioften Iexhibit
Iincreased IHCT Ilevels Iand Ican Idevelop Ia Icondition Icalled Isecondary Ipolycythemia Ivera.
10. Mechanism Iof Iaction Iof Ianticholinergic Idrugs Ito Itreat Iasthma:
Anticholinergic Idrugs Ibind Ito Imuscarine Ireceptors Iand Iblock Ithe Iaction Iof Iacetylcholine IThey
Ireduce IBroncho Imotor Itone I=bronchodilation: Iblock Iacetylcholine Ibinding, Ibronchodilation,
Idecrease Iparasympathetic Iresponse
Cardiovascular:
11. Review Iconcepts Iof ICardiac IOutput:
Cardiac IOutput= IHeart Irate Ix IStroke Ivolume\
Cardiac Ioutput: Iis Ithe Ivolume Iof Iblood Iejected Iby Ieach Iventricle Iper Iminute
(75 Ibpm Ix I70ml I= I5.25 IL/min) I5 IL Iof Iblood Iin Ithe Ibody= Ievery Idrop Iof Iblood Icirculates Ithe Ibody
-per Iheartbeat Iper Iminute
Cardiac Ioutput Idecrease Iwith Iage Iat Ia Irate Iof I1% Iper Iyear Iafter Ithe Iage Iof I30 I(other Ifactors
IcanIaccelerate Ithe Irate Iof Idecline)
Cardiac Ioutput Iis Ia Ikey Icomponent Iof IHF Iand Iis Iimportant Ito Iunderstand Ithe Iconnection Ib/t IHR
I&ISV:
DECRESE Iin IHR I(longer Ifilling Itime) IINCREASE Iin
ISVIINCREASE Iin IHR I(shorter Ifill Itime) IDECREASE Iin
ISV
12. Concepts Iof Icardiac Icontractility:
IContractility I(ionotropic Istate)
Contractility Iis Idetermined Iby ICalcium Iavailability Iand Iits Iinteraction Iwith Iactin Iand Imyosin
I I I I
Pulmonary
1. Concepts Iof Ianticholinergic Idrug Iand Iasthma:
Anticholinergic Idrugs: Iblock Iacetylcholine Ibinding I(primarily Iin Ithe Ilungs) I-promotes Ibronchiole
Idilation Ithrough Idecrease Iin Ithe Iparasympathetic Iresponse I(tiotropium I& Iipratropium) Iis Ifast
Iacting
2. Bronchitis I& Iassociated Ipathogenesis:
Begins Iwith Ian Iexposure Ito Ian Iirritant I(tobacco Ismoke) I– Iactivates Ibronchiole Ismooth Imuscle
Iconstriction- Imucus Isecretion- Irelease Iof Iinflammatory Imediators(histamine, Iprostaglandins I&
Ileukotrienes) Inormal Iresponse Ito Ioccasional Iairborne Isite Iirritants- Iover Ibronchitis Iis Iover Ilong
Iterm I3 Imonths Ifor Iover I2 Iconsecutive Iyears- I= Ismooth Imuscle Ihypertrophy I= Iincrease
Ibronchoconstriction, Ihypertrophy Iand Ihyperplasia Iof Igoblet Icells= Imucus Ihypersecretion,
Iepithelia Icell Imetaplasia I= Inon-ciliated Isquamous Icells, Imigration Iof Imore IWBCs Ito Isite I=
Iinflammation Iand Ifibrosis Iin Ibronchial Iwall, Ithickening Iand Irigidity Iof Ibronchial Ibasement
Imembrane= Inarrowing Iof Ibronchial Ipassageways I: IIncreased Imucus Iproduction- Iinflammation
Iprocess I= Iweight Iloss, Iloss Iof Iappetite, Imuscle Iweakness I(interleukin Icontrols Iappetite)
Iincreases Iprotease Iactivity= Ibreakdown Iof Ielastin Iin Ithe Iconnective Itissues Iof Ithe Ilung=
Idestruction Iof Ithe Iwall Ibetween Ithe Ialveoli Iand Ilungs I= Ilarge Iineffective Iair Isacs Idevelop-elastic
Irecoil Iof Ibronchial Iwall I-destroys Ibronchi Iand Icant Idilate Iand Ithey Istay Iconstricted I=air Itrapping
I: IChronic Ibronchitis
=Dyspnea- Iair Itrapping Iincreased Imucus, Iincrease IWOB Ir/t Ichronic Ibronchoconstriction
ICough- Iirritated Iand Iinflamed Ibronchial Iepithelia Imembrane IHypoxia I& IHypercapnia I-
fromIimpaired Igas Iexchange
3. Chronic Ibronchitis Iand Irelated Iacid/base Idisturbance:
Hypercapnia I(CO2 Iretention) I= IRespiratory Iacidosis
r/t Ianatomical Ichanges Iventilation Iis Icompromised Iesp. Iexhalation I= Ialveolar Ihyperinflation)
Iexpanded Ithorax) Ihypercapnia ICO2 Iretention I= Irespiratory Iacidosis\
4. Perfusion:
the Iactual Iexchange Iof IO2 Iand ICO2 Iin Ithe Ibloodstream Ioccurs Ivia Ithe Ialveoli Iand Ipulmonary
Icapillaries: Ithe Ipassage Iof Ifluid Ito Ian Iorgan Ior Ia Itissue Iusually Ireferring Ito Idelivery Iof Iblood Ito Ian
Iarea
5. Blood Iflow Ibetween Ithe Iheart Iand Ilungs Iin Ichronic Ibronchitis:
Poor Iventilation Ileads Ito Ir Ito Il Ishunting Ito Ioccur= Ideoxygenated Iblood Ipasses Ifrom Ir Iventricle Ito
Ithe Ilungs Ito Ithe Il Iventricle Iwithout Iadequate Iperfusion I(gas Iexchange) Ithe Ikidneys Irespond Iby
Isecreting Ierythropoietin Iincreasing IRBC Iproduction Ithe Iincrease Iin IRBC Iincrease IO2 Icarrying
Icapacity I-the Iincrease Iblood Ivolume Iincreases Ithe Iworkload Iof Ithe Ipulmonary Iand
IcardiovascularIsystems Iincreasing Iblood Ivolume Iand Ivasoconstriction I= Ipulmonary IHTN=
Iincrease Iworkload IonIthe IR Iventricle I=cardiac Ihypertrophy= IR Iside IHF Ior ICor IPulmonale
6. Asthma Isigns Iand Isymptoms:
Coughing Iesp. Iat Inight, Ichest Itightness, Ishortness Iof Ibreath, Iwheezing Ion Iexhalation, Iand Irapid
Ibreathing: ICharacteristics: Iairway Iinflammation, Ibronchial Ihyperactivity, Ismooth Imuscle Ispasms, I=
, excessive Imucus Iproduction, Ihypertrophy Iof Ibronchial Ismooth Imuscle I-obstruction Iand Idecrease
Ialveolar Iventilation
7. Bronchioles Iin Iasthma:
There Iare I3 Ilayers Iof Ithe Ibronchiole Iwhich Iis Ia Itube-like Istructure Isurrounding Ithe Ilumen Ior Iairway
Ipassageway: Iinnermost Ilayer Iis Icomposed Iof Icolumnar Iepithelial Icells Iand Igoblet Icells-
The Ioutermost Ilayer Iis Icomposed Iof Ismooth Imuscle Icells Iresponsible Ifor Ithe Iability Iof Ithe Iairway
Ito Iconstrict Iand Idilate I– Ithe Imiddle Ilayer Iis Ithe Ilaminar Ipropria Iand Iit Iis Iembedded Iwith
IconnectiveItissue Iand Iimmune Icells: Iin Iasthma Ithese Iprotective Ifeatures Igo Ioveractive
I=inflammation Iresponse= Idamage Ito Ihost Itissue=hypertrophy Iof Ithe Ibronchioles Ismooth Imuscle
Iand Iexcessive Imucus Iproduction: Ibronchioles Ispasm-mucus Iproduction-obstruction
8. Alveolar Ihyperinflation Iwith Iasthma:
Increase Imucus Iproduction Ifrom Ithe Igoblet Icells Iin Ithe Iinflammation Iprocess Iforms Iplugs Iof Imucus
Iand Ipus Iand Iblock Ialveolar Ipassageways Ileading Ito Iair Itrapping Iand Ihyperinflation I= Ierosion Iof
Iairway Itissue
9. Polycythemia IVera:
a Irare Iblood Idisease Iin Iwhich Ithe Ibody Imakes Itoo Imany IRBCs Imaking Ithe Iblood Ithicker Ithan
Inormal Icausing Iblood Iclots; Iis Ioften Ia Iresult Iof Ichronic Ilow Ilevels Iof IO2 Iin Ithe Iblood, Ithe Ikidney
Icompensates Iby Iincrease Isecretion Iof Ierythropoetin, Ithe Iprimary Ihormone Iresponsible Ifor
Istimulating IRBC Iproduction= Ias Ia Iresult Ipatients Iwith Ichronic Ibronchitis Iwill Ioften Iexhibit
Iincreased IHCT Ilevels Iand Ican Idevelop Ia Icondition Icalled Isecondary Ipolycythemia Ivera.
10. Mechanism Iof Iaction Iof Ianticholinergic Idrugs Ito Itreat Iasthma:
Anticholinergic Idrugs Ibind Ito Imuscarine Ireceptors Iand Iblock Ithe Iaction Iof Iacetylcholine IThey
Ireduce IBroncho Imotor Itone I=bronchodilation: Iblock Iacetylcholine Ibinding, Ibronchodilation,
Idecrease Iparasympathetic Iresponse
Cardiovascular:
11. Review Iconcepts Iof ICardiac IOutput:
Cardiac IOutput= IHeart Irate Ix IStroke Ivolume\
Cardiac Ioutput: Iis Ithe Ivolume Iof Iblood Iejected Iby Ieach Iventricle Iper Iminute
(75 Ibpm Ix I70ml I= I5.25 IL/min) I5 IL Iof Iblood Iin Ithe Ibody= Ievery Idrop Iof Iblood Icirculates Ithe Ibody
-per Iheartbeat Iper Iminute
Cardiac Ioutput Idecrease Iwith Iage Iat Ia Irate Iof I1% Iper Iyear Iafter Ithe Iage Iof I30 I(other Ifactors
IcanIaccelerate Ithe Irate Iof Idecline)
Cardiac Ioutput Iis Ia Ikey Icomponent Iof IHF Iand Iis Iimportant Ito Iunderstand Ithe Iconnection Ib/t IHR
I&ISV:
DECRESE Iin IHR I(longer Ifilling Itime) IINCREASE Iin
ISVIINCREASE Iin IHR I(shorter Ifill Itime) IDECREASE Iin
ISV
12. Concepts Iof Icardiac Icontractility:
IContractility I(ionotropic Istate)
Contractility Iis Idetermined Iby ICalcium Iavailability Iand Iits Iinteraction Iwith Iactin Iand Imyosin
