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Flashcards in Pulmonary Deck (57)
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1

What kind of epithelia line the respiratory tract?

nasal cavity and paranasal sinuses = cuboidal 

pharynx and larynx = squamous 

trachea and bronchi = cuboidal

 

2

What are the main functions of the respiratory system?

primary = respiration

2. voice

3. immune (MALT & alveolar macrophages)

4. metabolic, acid-base balance

 

3

Describe the respiratory defense system.

MALT means mucosa-assoc. lymph tissue. 

- forms tonsils in the nasopharynx and pharynx + lymphoid follicles in bronchi

 

Alveolar macrophages

- phagocytic cells, can be found in sputum. Pulmonary capillaries mobilize leukocytes quickly to sites of infection.

4

What are the main respiratory diseases?

- infectious disease

- immune diseases

- environmentally induced

- circulatory disease

- tumors

5

Compare the infections of the upper respiratory system with those of the so-called middle respiratory system.

URI: infection/inflammation of the nose, paranasal sinuses, throat, larynx . . .may spread to the middle ear, and tracheobronchial tree

 

MRI: larynx, trachea, extrapulmonary bronchi.

 

 

6

What could cause a "runny nose"?

Most URIs are viruses. In viral infections, lymphocytes, macrophages, and plasma cells infiltrate and cause congestion and edema.

Severe infections can cause ulceration of the mucosal epithelial lining, which allows entry of bacteria.

7

What is croup?

An acute life-threatening infection involving the larynx. 

 

Inflammation causes swelling and laryngospasm. The vocal cords spasm and cause "barking cough". Typically caused by parainfluenza virus. 

8

Compare epiglotittis and bronchiolitis.

Epiglottitis = h. influenzae

sudden loss of voice and hoarseness, pain with swallowing. edema and narrowing of the air passage. requires antibiotic therapy.

 

bronchiolitis = RSV

wheezing, low-grade fever, SOB. virus invades epithelial cells of the bronchi and bronchioli, causing cell death and desquamation. Edema of airway and dead cells cause obstruction of the bronchi and bronchioli.

9

Compare alveolar and interstitial pneumonia.

aveolar

- focal or diffuse

- most often caused by bacteria
* often superimposed on pulmonary edema of CHF

lobar

- usually diffuse
- often bilateral
- most often caused by viruses
 

10

List the common causes of pneumonia and give specific characteristics about each of these forms of lung infection.

- upper respiratory flora

strep pneumo
H. influenzae

staph aureus

- enteric saprophytes
E. coli
p. aeruginosa

- extaneous pathogens
legionella
TB
herpesvirus, CMV

11

Compare lobar pneumonia and bronchopneumonia with interstitial pneumonia.

12

List 3 complications of bacterial pneumonia.

  1. pleuritis
    inflammation commonly >> pleural effusion. 
    pus = pyothorax
    fibrous tissue = empyema
  2. abscess
    usually associated with highly virulent bacteria (Staph)
  3. chronic lung disease
    pus causes destruction and bronchial dilation (bronchiectasis). 
    fibrosis >> honeycomb lungs

13

Compare community-acquired pneumonia and hospital-acquired pneumonia.

primary (community-acquired) = 
affects previously healthy people

secondary (or nosocomial) =
affects those with pre-existing illness

14

What are the clinical signs of pneumonia?

systemic

- fever, chills

 

local irritation

- coughing, chest pain, expectoration

 

airway obstruction

- dyspnea, tachypnea


inflammation

- tissue destruction, bleeding

15

Explain the concept of atypical pneumonia and give specific examples of this clinicopathologic entity.

atypical = pneumonias that do not present with classical symptoms
examples = viruses, mycoplasma pneumo

16

Compare primary and secondary tuberculosis.

Primary . . . occurs in a person not previously exposed.
symtoms = mild & lo fever

 

Secondary . . . is a reactivation of a dormant primary infection or a reinfection.

symptoms = dry cough, fever, loss of appetite, malaise, night sweats, weight loss

17

Which fungi cause pneumonia and under what circumstances?

community acquired = histoplasmosis, coccidiodomycosis

hosptial acquired (esp AIDS) = PCP, candida, aspergillus

18

Which pathogens cause pulmonary abscesses?

most common = s. aureus

less often = klebsiella, pseudomonas

19

Compare chronic obstructive pulmonary disease caused by chronic bronchitis and COPD caused by emphysema.

Chronic bronchitis = "blue bloaters"

- bouts of coughing, purulent mucus, dyspnea
- pulm. HTN, cor pulmonale

emphysema = "pink puffers"

- no bronchial obstruction, no irritation (therefore no coughing)
- tachypnea
- barrel chest

20

What is bronchiectasis, and how does it develop?

a permanent dilation of the bronchi

result of persistent inflammation of the airways. Enzymes from bacteria and leukocytes + mechanical pressure + fibrous scars

21

Compare centrilobular and panacinar emphysema.

centrilobular = widening of the airspae in the center of a lobule and involves predominantly respiratory bronchioles
most common form of emphysema, smoking

panacinar = airspaces distal to the terminal bronchioles
alpha-1AT deficiency

22

List the most important immune diseases of the respiratory tract.

  1. sarcoidosis
  2. hypersensitivity pneumonitis
  3. bronchial asthma
  4. allergic rhinitis

23

Explain the pathogenesis of asthma.

increased responsiveness of the bronchial tree to stimuli

allergens can trigger the release of mediators from mast cells, which act on the blood vessels and smooth muscle cells. Mediators released from chronic inflammatory cells in the wall of the bronchus also stimulate mucous secretion and contraction of the smooth muscle cells. 

24

Compare extrinsic and intrinsic asthma.

extrinsic
- exogenous allergens
- type 1 hypersensitivity

intrinsic
- nonimmune
- hyperreactivity of the bronchial tissues

25

What is sarcoidosis, and how does it affect the body?

multisystemic ganulomatous disease

2x more common in AA women than men
10:1 (CD4:CD8)
may have dyspnea, cough, wheezing, low fever, lymphadeopathy

key = noncaseating granuloma

26

List several important antigens that cause hypersensitivity pneumonitis.

farmer's lung . . . moldy hay
bagassosis . . . sugar cane
maple bark dx . . . maple bark
mushroom worker's lung . . . mushrooms
humidifier lung . . . contaminated fluid
pigeon-breeder's lung . . . droppings
furrier's lung . . . animal pelts

27

Compare acute and chronic hypersensitivity pneumoitis.

acute
mediated by antibodies that react with inhaled antigens. will evolve over several hours
* sudden onset dyspnea

chronic
T lymphocyte mediated. granulomas may from in alveolar septa and damages tissue (fibrosis).
chronic dyspnea, hyperventilation, ult resp failure

28

What is pneumoconiosis?

= lung diseases caused by inhalation of mineral dusts, fumes, and other particulate matter

29

How does inhalation of mineral particles damage the lungs?

  • Coal: less reactive, develops only after long exposure to high levels
  • silica: more reactive, produce prominent tissue injury
  • asbestos: insoluble, remain in lungs permanently

30

Explain the effect of air pollutants on the lungs.

small particles = taken up by macrophages (<5 microm)
large particles = stay in nasal mucosa (>10)

macrophages stimulated by the ingested particles release cytokines (IL-1) and TNF, which promote inflammation and stimulate the proliferation of fibroblasts and the formation of collagen