Respiratory System Pathology

Question 1

Define asthma

Answer 1

Chronic inflammatory airway disease

Question 2

What is asthma characterized by

Answer 2

Increased responsiveness of trachea & bronchi to various stimulus

Question 3

What is asthma manifested by

Answer 3

Widespread narrowing of AW that changes in severity either spontaneously or w therapy

Question 4

What is the pathophysiology behind an acute asthma attack

Answer 4

AW narrowing d/t smooth muscle contraction, as the attack continues mucosal edema & mucous production increases

Question 5

What are common stimuli for asthma exacerbations

Answer 5

Allergens, infections, cold temp, exercise

Question 6

What are the ‘early’ symptoms of asthma

Answer 6

Wheeze, cough, dyspnea

Question 7

What are the early signs/findings of asthma

Answer 7

Cough, anxiety, tachycardia, increased RR, AMU, nasal flaring, inability to lie down

Question 8

What lung sounds do you expect to hear in an asthmatic pt that is still breathing

Answer 8

Inspiratory & expiratory wheezes

Question 9

What will happen pathologically if the asthma attack continues

Answer 9

Pt will not be able to compensate for bronchoconstriction with tachypnea, therefore RR will decrease, there will be a decreased in O2 & increase in CO2, silent chest due to respiratory arrest, finally cardiac arrest

Question 10

What is status asthmaticus

Answer 10

The severe acute asthma attack that is not improving with standard tx

Question 11

Why is dyspnea important to note

Answer 11

It can indicate the severity of respiratory distress (<2 words is bad!!)

Question 12

CODP

Answer 12

Chronic obstructive pulmonary disease

Question 13

What is the term typically given to pts w chronic AW obstruction

Answer 13

COPD

Question 14

What defines a chronic disease

Answer 14

Pt experiences symptoms for most days for 3 months out of a year, for at least 2 consecutive years

Question 15

What diseases are included in the COPD causes

Answer 15

Bronchitis, emphysema, asthma

Question 16

Define emphysema

Answer 16

Lung condition characterized by the abnormal permanent enlargement of the air spaces distal to the terminal bronchiole, plus the destruction of bronchiole walls

Question 17

Define bronchitis

Answer 17

Chronic or recurrent excessive mucus production in the bronchial tree, typically accompanied by a cough

Question 18

Why is it critical to understand the varying presentations of the diseases within COPD

Answer 18

Because pts can have a variety of the diseases, with one excluded therefore presentations and frequency of exacerbations can vary

Question 19

What is the pathophysiology behind emphysema

Answer 19

There is TONS of destruction to the alveolar septa (walls) and pulmonary vascular beds, which act as springs to splint open the bronchi (the elastic component of alveoli), this damage equates to bronchiole collapse

Question 20

In the emphysemic, what are the two main problems that AW collapse can cause

Answer 20

Increase airflow obstruction or overinflation of air sacs

Question 21

Describe the term and presentation of a COPD pt suffering from emphysema

Answer 21

“Pink puffer” : thin, anxious, A&O, dyspneic, hyperventilating

Question 22

What are physical findings in the COPD pt suffering from emphysema, and what is the reason for each finding

Answer 22

AMU (to fight for O2), pursed lips on expiration (increased AW pressure = internally splinting AW open), increased chest diameter (d/t chronic over distension of AW, decreased respiratory reserve & sedentary lifestyle with low immobile diaphragm)

Question 23

What is critical to keep in mind with emphysemic pts

Answer 23

Any lung insult can cause respiratory failure, therefore key to keep in mind rib #s, pneumonia, excessive coughing & the risk of barotrauma/pneumothorax

Question 24

If you have markedly decreased or absent A/E in one lung in an emphysemic what should you consider the possibility of

Answer 24

Pneumothorax & the high possibility of rapid deterioration

Question 25

What is the end all and be all for treatment of an emphysemic pt

Answer 25

Lung transplant

Question 26

Describe the term and presentation of a COPD pt suffering from bronchitis

Answer 26

“Blue bloaters” : chronic central cyanosis from decreased O2 saturations, d/t V/Q mismatch (shunting) in the lungs

Question 27

What characterized bronchitis

Answer 27

A chronic cough with productive sputum

Question 28

Why do pts suffering from bronchitis have the potential to deteriorate quickly

Answer 28

High risk of pneumothorax, PE, atelectasis

Question 29

Why may pneumonia be devastating in the pt suffering from bronchitis

Answer 29

Because without the ability to entirely clear the lungs substantial AW collapse may occur

Question 30

What is a large concern for blue bloaters, even more so than pink puffers

Answer 30

Rib #

Question 31

What can cause excessive nasal secretions

Answer 31

Can possibly be the result of URT mucosal irritation, either d/t infection, allergen or mechanical/chemical sources

Question 32

What is sneezing

Answer 32

The forced exhalation of air through the nose in attempt to remove mucosal irritants

Question 33

What is coughing

Answer 33

The defense mechanism of the LRT to clear the AW

Question 34

What are the four various causes of coughing

Answer 34

— Inflammatory (infection, asthma) — Mechanical (dust, aspirated material) — Chemical (irritating noxious gases, smoke, Cl2) — Thermal (cold air)

Question 35

What are the various colours & causes of sputum or blood

Answer 35

— Grey/white, mucoid, sticky sputum may be the normal for COPD pts (especially w bronchitis) — Yellow/green likely relates to infection — Blood can mean bronchitis, pulmonary edema, lung CA

Question 36

Various causes of chest pain

Answer 36

— Chest wall — Pleura — Pericardial — Diaphragm — Esophageal irritation — Cardiac ischemia — Aortic dissection — Esophageal rupture

Question 37

Describe chest wall pain causes

Answer 37

- Skin (burning, constant, can be mild to excruciating) - Ribs (#s, usually associated with trauma, often worse on movement/breathing/palpation, mod-severe) - Costal cartilages (costochondritis, similar to rib # but less severe) - Muscle (muscle spasm, similar to rib # but much worse on movement) - Nerves (shingles, constant/burning pain, mild-mod severity)

Question 38

Describe pleural pain and causes

Answer 38

Stabbing, knife-like, worse on breathing/movement/coughing, mod-excruciating Possible causes: pleurisy, pneumonia, pulmonary infarctions

Question 39

Describe pericardial pain and causes

Answer 39

Similar to pleural pain but characterized by begin worse with movement, often mod-severe Possible causes: pericarditis or MI

Question 40

Describe diaphragm pain and causes

Answer 40

Similar to pleural pain, often d/t irritation from above (ie lower lobe pneumonia, pulmonary infection, free peritoneal blood/air) characterized by referred pain to 1+ shoulders

Question 41

What is key to know about esophageal irritation

Answer 41

It is typically described as burning and is otherwise indistinguishable from an MI

Question 42

Describe key characteristics of cardiac ischemia

Answer 42

— Tightness, heavy, pressure — Center of chest, may radiate to arm/neck/jaw — Does NOT increase with breathing/movement — Pt may be nauseous & quite diaphoretic

Question 43

Describe details of aortic dissection

Answer 43

— Usually sudden onset severe centralized chest pain — Pain begins anteriorly then may migrate to interscapular region &/or lower back — Often associated with N/V & diaphoresis — SYS between arms varying by >/=15mmHg between arms is not good (it indicates that an aortic dissection has taken path along subclavian arteries) HoTN is an ominous sign!!

Question 44

Describe details of esophageal rupture

Answer 44

— Rare, pain is usually pleuritic, may be constant, may radiate to back pain and can be worse on movement — Often caused by instruments inserting in esophagus for medical purposes — Severe, central chest &/or epigastric pain, usually after sudden increase in intrathoracic pressure After coughing, weightlifting, N/V After med instrument insertion (ie esophageal AW device, gastric lavage esophagoscopy)

Question 45

What is dyspnea

Answer 45

The sensation of difficult breathing (can be normal or abnormal)

Question 46

Describe the dyspnea tree

Answer 46

Abnormal — Nonpsychogenic (hyperventilation) — Psychogenic — Pulmonary (obstructive/asthma, restrictive/pulmonary fibrosis, vascular/PE) — Cardiac (LVH) — Haematological (anemia) — Metabolic (hyperthyroidism, CO poisoning) Normal

Question 47

Describe SOB

Answer 47

The subjective sensation of not being able to catch one’s breath

Question 48

Describe hypoxia

Answer 48

Lack of insufficient O2 to allow proper functioning of the brain & other vital organs

Question 49

What are possible roots of dyspnea

Answer 49

— Cardiovascular (ie cardiogenic shock or hypovolemia) — Respiratory (ie severe pulmonary edema) — Haematological (ie severe anemia, CO poisoning)

Question 50

What are various signs of hypoxia

Answer 50

CNS disturbances (anxiety combativeness, visual disturbances, dysarthria, confusion, seizure, coma), cyanosis, cardiac arrhythmias, tachycardia & diaphoresis

Question 51

What directly follows preterminal hypoxia

Answer 51

Respiratory arrest

Question 52

Describe cyanosis

Answer 52

The blue-ish discolouration of the skin & mucous membranes d/t an increase in deoxygenated blood

Question 53

What patients may you see cyanosis late in

Answer 53

Polycythemic pts (abnormally high RBC count)

Question 54

What is cyanosis

Answer 54

A late sign of hypoxia

Question 55

What is hypercapnia

Answer 55

Increased level of CO2 in blood results when ventilation is insufficient, where most will be hyperventiliating)

Question 56

What are the most common causes of hypercapnia

Answer 56

— Decreased central respiratory drive (ie narcotic OD) — Spinal cord transection) — Neuromuscular diseases (ie myasthenia gravis) — COPD (chronic CO2 retainers) — Asthmatic pt who is no longer compensating therefore in respiratory arrest

Question 57

What are mains signs of hypercapnia and why

Answer 57

Headache (d/t increased ICP from the dilation of CO2), if CO2 increases further pt may become confused, somnolent or comatose