What pathophysiologic change(s) occur in the body when a person has emphysema? Select all that apply.
The septae and walls of the alveoli are destroyed.
Formation of elastic fibers allows the lungs to recoil.
Alveolar air spaces become permanently inflated.
Bronchial wall thickening leads to narrowed airways.
Pulmonary capillaries are lost, affecting perfusion.
Correct Answer : A,C,E
Choice A rationale
In emphysema, chronic exposure to irritants like cigarette smoke triggers an inflammatory response that releases proteases, such as elastase. These enzymes break down the elastin and collagen in the alveolar septae. The destruction of these walls leads to a loss of surface area for gas exchange. This structural breakdown is irreversible and results in the merging of small alveoli into larger, less efficient air sacs, significantly impairing the diffusion of oxygen.
Choice B rationale
This statement is incorrect because emphysema actually involves the destruction of elastic fibers. Under normal conditions, elastic recoil allows the lungs to passively exhale air. In emphysema, the loss of elastin means the lungs lose their "springiness.”. Consequently, the airways tend to collapse during expiration, trapping air inside the lungs. This leads to the characteristic hyperinflation and barrel chest seen in patients, as they cannot effectively expel the air they inhale.
Choice C rationale
Alveolar air spaces become permanently inflated due to the loss of elastic recoil and the collapse of small airways during exhalation. This phenomenon is known as air trapping. As the patient breathes in, air enters the enlarged alveolar spaces, but because the structural support is gone, the air cannot be easily pushed out. This permanent enlargement increases the residual volume of the lungs and decreases the amount of fresh, oxygenated air that can be inhaled.
Choice D rationale
Bronchial wall thickening and narrowed airways are the primary pathophysiologic hallmarks of chronic bronchitis, not emphysema. While both are types of chronic obstructive pulmonary disease and often coexist, emphysema is specifically defined by structural changes in the alveolar walls and distal air spaces. Chronic bronchitis focuses on the inflammation of the large and small airways, characterized by mucus hypersecretion and goblet cell hyperplasia, which differs from the parenchymal destruction of emphysema.
Choice E rationale
The destruction of alveolar walls inevitably leads to the loss of the pulmonary capillaries that run within them. This creates a "dead space" effect where ventilation occurs, but there is no blood flow to pick up oxygen or drop off carbon dioxide. The reduction in the capillary bed increases pulmonary vascular resistance, which can eventually lead to pulmonary hypertension and right-sided heart failure, further complicating the respiratory status of the affected individual.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
The kidneys are responsible for producing erythropoietin, a hormone that signals the bone marrow to produce red blood cells. In chronic renal failure, the functional peritubular cells in the kidney are damaged and cannot produce sufficient amounts of this hormone. Without enough erythropoietin, the bone marrow does not receive the necessary stimulus to maintain an adequate red blood cell count, leading to the development of normocytic, normochromic anemia in these patients.
Choice B rationale
While iron deficiency can cause anemia, it is not the primary physiologic cause of anemia specifically linked to chronic renal failure. Chronic kidney disease patients may have iron issues due to blood loss during dialysis or poor diet, but the fundamental renal cause is hormonal. While some malabsorption might occur in uremic states, it does not explain the consistent drop in hemoglobin as effectively as the lack of erythropoietin production by the failing kidneys.
Choice C rationale
Vitamin B12 deficiency causes megaloblastic anemia and is usually related to pernicious anemia, gastric surgery, or dietary deficiencies. While a person with renal failure could theoretically have a B12 deficiency, it is not the direct result of the renal pathology itself. The anemia of chronic kidney disease is characterized by the failure of the kidney's endocrine function, specifically the erythropoietin pathway, rather than a failure to absorb or utilize B12.
Choice D rationale
Circulating uremic toxins in chronic renal failure can slightly shorten the lifespan of red blood cells from the normal 120 days to a shorter duration. However, this is considered a secondary or contributing factor rather than the primary cause of the profound anemia seen in these patients. The dominant mechanism remains the inadequate production of erythropoietin, as the body cannot compensate for even a minor reduction in cell lifespan without the hormonal signal.
Correct Answer is ["A","B","C"]
Explanation
Choice A rationale
Fragile skin is a characteristic manifestation of Cushing's syndrome due to the catabolic effects of excess cortisol. Cortisol inhibits the synthesis of collagen and connective tissue, leading to thinning of the dermis. This makes the skin prone to easy bruising, slow wound healing, and the development of wide, purple striae, particularly on the abdomen. The loss of structural integrity in the skin is a direct result of the prolonged hypercortisolemia affecting protein metabolism.
Choice B rationale
Muscle wasting is caused by the high levels of cortisol promoting the breakdown of proteins, especially in the extremities. Cortisol stimulates gluconeogenesis by mobilizing amino acids from skeletal muscle. This leads to the characteristic thin arms and legs seen in patients with Cushing's syndrome. This proximal muscle weakness can make it difficult for patients to perform basic tasks, such as rising from a chair or climbing stairs, due to the significant loss of muscle mass.
Choice C rationale
Moon face refers to the rounded, plethoric facial appearance that occurs in Cushing's syndrome. This is caused by the abnormal redistribution of fat triggered by chronic glucocorticoid excess. Cortisol promotes lipogenesis in specific areas, leading to fat accumulation in the face, the supraclavicular regions, and the posterior cervicodorsal area, often called a buffalo hump. This facial rounding is one of the most recognizable clinical signs used to diagnose the presence of hypercortisolism.
Choice D rationale
Cushing's syndrome does not cause hypoglycemia; instead, it causes hyperglycemia. Cortisol is a counter-regulatory hormone that opposes the action of insulin and increases blood glucose levels by stimulating the liver to produce glucose and decreasing the sensitivity of peripheral tissues to insulin. Therefore, patients with Cushing's syndrome often develop secondary diabetes mellitus or impaired glucose tolerance, with blood sugar levels consistently remaining above the normal fasting range of 70 to 99 mg/dL.
Choice E rationale
Weight loss is not associated with Cushing's syndrome. In fact, generalized weight gain and central obesity are hallmark features of the condition. While the limbs may appear thin due to muscle wasting, the trunk and face accumulate significant adipose tissue. This truncal obesity, combined with a moon face and buffalo hump, creates the classic Cushingoid appearance. Weight loss would be more indicative of adrenal insufficiency, also known as Addison's disease, which is the opposite of Cushing's.
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