Guided Lecture Notes
Chapter 22: Disorders of Ventilation and Gas Exchange
Learning Objective 1. State the characteristics of pleural pain and differentiate it from
other types of chest pain.

Review the structures of the pleura (parietal, visceral, pleural cavity/space) (refer
to PowerPoint Slide 7 and Fig. 22-1).

Describe pleuritic chest pain, and explain how it differs from musculoskeletal
pain, pain caused by bronchial irritation, and pain due to myocardial disease.
Learning Objective 2. Differentiate among the causes and manifestations of
spontaneous pneumothorax, secondary pneumothorax, traumatic pneumothorax, and
tension pneumothorax.

Compare the causes, pathology, and clinical manifestations of spontaneous
(primary and secondary), traumatic, and tension pneumothorax (refer to
PowerPoint Slides 9–11 and Figs. 22-2 and 22-3).

Discuss the diagnosis and treatment of the various types of pneumothorax.
Learning Objective 3. Characterize the pathogenesis and manifestations of pleural
effusion.

Define pleural effusion, and identify the various types of fluid involved.

Compare the causes, characteristics, and clinical manifestations of hydrothorax,
empyema, chylothorax, and hemothorax (refer to PowerPoint Slide 14).

Discuss the diagnosis and treatment of pleural effusion.
Learning Objective 4. Describe the causes and manifestations of atelectasis.

Define atelectasis, and identify common causes (refer to Fig. 22-4).

Describe the clinical manifestations, diagnosis, and treatment of atelectasis.
Learning Objective 5. Describe the physiology of bronchial smooth muscle as it relates
to airway disease.

Trace the movement of air from trachea to alveoli.

Differentiate between upper and lower/pulmonary airways with regard to
structure and function.

Explain how bronchial smooth muscle tone affects bronchial lumen size.
Learning Objective 6. Describe the interaction between heredity, alterations in the
immune response, and environmental agents in the pathogenesis of bronchial asthma.

Identify common triggers that initiate bronchoconstriction in the asthmatic
patient.

Describe how the above responses result in airway obstruction (refer to
PowerPoint Slide 18).
Learning Objective 7. Compare and contrast extrinsic (atopic) asthma and intrinsic
(nonatopic) asthma.

Differentiate between extrinsic/atopic and intrinsic/nonatopic asthma with regard
to causes and type of allergic response to antigens (refer to PowerPoint Slides
16–17).

Describe the pathology and clinical manifestations of asthma.
Learning Objective 8. Characterize the early-phase and late-phase responses in the
pathogenesis of bronchial asthma, and relate them to the current methods of treatment of
this disorder.

Explain the pathology and mechanisms of early- and late-phase IgE-mediated
bronchospasm, and discuss treatment for each phase (refer to Figs. 22-5 and 226).
Learning Objective 9. Explain the changes in pulmonary function testing that occur
with airway disease.

Explain how PFT is used to diagnose and treat asthma.

Describe the typical PFT results for the various classifications of asthma (refer to
Table 22-1).
Learning Objective 10. Explain the distinction between chronic bronchitis and
emphysema in terms of pathology and clinical manifestations.

Compare the causes, pathology, clinical manifestations, and treatment of chronic
bronchitis and emphysema (refer to PowerPoint Slides 21–23 and 25, and Fig.
22-7).

Identify the various types of emphysema (refer to PowerPoint Slide 24 and Figs.
22-9 and 22-10).

Differentiate structural characteristics between “pink puffers” and “blue bloaters”
(refer to PowerPoint Slide 26 and Table 22-2).
Learning Objective 11. State the chief manifestations of bronchiectasis.

Describe the structural changes that occur in bronchiectasis, and discuss the
pathogenesis associated with obstruction and chronic infection (refer to Fig. 2212).

Differentiate between localized and generalized bronchiectasis.

Describe the clinical manifestations, diagnosis, and treatment of bronchiectasis.
Learning Objective 12. Describe the genetic abnormality responsible for cystic fibrosis
and state the disorder’s effect on lung function.

Describe the genetic mutation responsible for CF.

Describe the pathology, clinical manifestations, diagnosis, treatment, and
prognosis of CF (refer to PowerPoint Slides 32–33 and Fig. 22-13).
Learning Objective 13. State the difference between chronic obstructive pulmonary
diseases and interstitial lung diseases.

Explain how interstitial lung disease differs from obstructive lung disease.

Identify examples of interstitial lung disease (refer to Chart 22-1).
Learning Objective 14. State the most common cause of pulmonary embolism and the
clinical manifestations of the disorder.

Differentiate between thrombus and embolus.

Identify causes of PE, and describe associated clinical manifestations, diagnosis,
and treatment (refer to Fig. 22-14).

Discuss ways to prevent the occurrence of PE.
Learning Objective 15. Describe the physiology of pulmonary arterial hypertension and
state three causes of secondary pulmonary hypertension.

State the value (in mm Hg) that defines PA HTN.

Differentiate between primary and secondary PA HTN with regard to causes,
signs and symptoms, diagnosis, and treatment (refer to PowerPoint Slide 35).
Learning Objective 16. Describe the alterations in cardiovascular function that are
characteristic of cor pulmonale.

Explain how chronic PA HTN may lead to cor pulmonale.

Describe the pathology, signs and symptoms, and management of cor pulmonale
(refer to PowerPoint Slide 36).
Learning Objective 17. Describe the pathologic lung changes that occur in acute
respiratory distress syndrome and relate them to the clinical manifestations of the
disorder.

Discuss the incidence and prognosis of ARDS.

Identify conditions that may lead to the development of ARDS (refer to Chart
22-2).

Describe the pathology of ARDS and the resulting clinical manifestations,
diagnosis, and treatment (refer to PowerPoint Slide 37 and Fig. 22-15).
Learning Objective 18. Define the terms hypoxia, hypoxemia, and hypercapnia.

Define the terms hypoxemia and hypercapnia, and state corresponding values
(refer to PowerPoint Slides 3–4).

Define hypoxia, and explain how hypoxemia leads to hypoxia.
Learning Objective 19. State a general definition for respiratory failure.

Identify causes of respiratory failure (refer to PowerPoint Slide 2 and Chart 223).

Explain what is meant by ventilation–perfusion mismatch (refer to PowerPoint
Slide 2).
Learning Objective 20. Characterize the mechanisms whereby respiratory disorders
cause hypoxemia and hypercapnia.

Explain how respiratory failure results in hypoxemia and hypercapnia.
Learning Objective 21. Compare the manifestations of hypoxemia and hypercapnia.

Compare the clinical manifestations of hypoxemia and hypercapnia.
Learning Objective 22. Describe the treatment of respiratory failure.

Discuss the diagnosis and treatment of respiratory failure.