Topic 32-37: Upper respiratory tract, restrictive and obstructive disorders

Question 1

infections of the upper respiratory tract include:

Answer 1

rhinitis
sinusitis
acute pharyngitis
tonsillitis
otitis media

Question 2

rhinitis includes several types. briefly describe

Answer 2

allergic rhinitis: hay fever, IgE response
Infectious rhinitis: common cold, catarrhal discharge, sneezing, sore throat. Viral!
Chronic rhinitis:repeated acute rhinitis attacks causing secondary bacterial infection with purulent exudate. occurs with nasal polyp

Question 3

sinusitis includes several types. briefly describe

Answer 3

acute sinusitis: preceding acute or chronic rhinitis. typically bacteria from oral cavity
chronic sinusitis: prolonged sinusitis, mixed microfloral infection or even mucor

Question 4

acute pharyngitis, descibe

Answer 4

can be viral or bacterial,

• rhinovirus, echovirus, adenovirus
• group a strep (more severe with tonsillitis, exudates)
• EBV

Question 5

tonilitis:

Answer 5

can be viral or bacterial, more often viral!!

• reddening, swollen, exudative tonsils
• streptococcal tonsillitis should be checked because it can lead to peritonsillar abscess, post strep glom nephritis, and acute rheumatic fever

Question 6

otitis media: what is it generally and it has two types

Answer 6

infection of middle ear typically due to eustachian tube, associated with hearing loss, especially seen in young children.

• acute OM- abrupt ear pain, blacked E tube leads to buildup of air, can be bacterial or viral
• chronic OM - no symptoms, buildup of fluid, can be bacterial or viral

Question 7

tracheitis is what ? complications?

Answer 7

inflammation of the trachea, almost always bacterial

• seen in children
• can cause airway obstruction
• symptoms are stridor, cough, fever, chest pain

long term incubation causes decubitus

Question 8

laryngitis has several types

Answer 8

• acute bacterial epiglottitis
• acute laryngitis
• laryngotracheobronchitis

Question 9

acute laryngitis is what? what are some rare forms that you should know?

Answer 9

inhalation of an irritant or infectious agent.

tuberculosis - coughing up infectious sputum
diphtheritic - pseudomembrane (fibropurulent exudate)

Question 10

laryngotracheobronchitis is what

Answer 10

normally due to parainfluenzae virus

• normally in children who live in dry places
• scary stridor and cough, can narrow airways to cause respiratory failure

Question 11

vascular pulmonary diseases include:

Answer 11

• pulmonary emboli –> hemorrhage and infarct
• pulmonary hypertension
• diffuse pulmonary hemorrhage
• atelectasis

Question 12

pulmonary embolisms are dependant on size of the occluded artery. what are the consequences depending on the artery occluded?

Answer 12

small

• alveolar hemorrhage
• If peripheral - infarct (only 10%)
• silent

medium
-alveolar hemorrhage

large

• decreased co
• RSHF
• hypoxemia
• death (due to >60% vasculature occlusion with large or multiple small emboli)

Question 13

what is the fate of the pulmonary emboli?

Answer 13

60-80% silent
10-15% - small or medium a obstruction –> infarct
5% death

Question 14

pulmonary hypertension is typically due to what?

Answer 14

Primary:

• idiopathic
• familial

secondary

• COPD or interstitial lung disease
• recurrent pulmonary emboli
• antecedent heart disease (atrial stenosis, right->left shunts, LVHF)
• NOTE: can be pulmonary arterial or venous hypertension in pathogenesis!!

Question 15

in primary pulmonary HT, what is the name of the condition and general pathogenesis?

Answer 15

uncommon familial pulmonary HT: proliferation of SM and vascular endothelial cells due to mutations of bone morphogenetic protein receptor type 2

Question 16

diffuse alveolar hemorrhage causes

Answer 16

goodpasture syndrome
idiopathic pulmonary hemosiderosis
wegener granulomatosis

Question 17

goodpasture syndrome is what?

Answer 17

antibodies against alpha3 chain of type 4 collagen

• shows linear Ig pattern
• hemorrhage and fibrosis

Question 18

idiopathic pulmo hemosiderosis is what?

Answer 18

unknown etiology, looks like goodpasture w/o Ig

Question 19

wegener granulomatosis is what?

Answer 19

pulmonary necrotizing vasculitis and granulomas, hemorrhage, upper airway involvement with sinusitis, nasal perforation
C-ANCA

++Remember Polyarteritis nodosa (p-anca) thus the other one is the other anca

Question 20

acquired atelectasis has three types

Answer 20

resorption
compression
contraction

Question 21

resorption atelectasis is:

Answer 21

airway obstruction causes trapped air to be resorbed and alveoli collapse

lung volume decreases and mediastinum is pushed towards the collapsed lung

Question 22

compression atelectasis

Answer 22

pleural cavity gets filled with fluid or air causing lung to be compressed

mediastinum shifts away from collapsed lung

Question 23

contraction ateletasis

Answer 23

fibrosis of pleura or lung prevents full expansion

Question 24

COPD is which 4 disorders? what is their FEV1/FVC ratio

Answer 24

asthma
emphysema
chronic bronchitis
bronchiectasis

ration is normal or decreased

Question 25

what are the anatomical locations of COPD?

Answer 25

all in the large airways/bronchi except emphysema is in the alveoli

Question 26

asthma is defined as what? what are the types?

Answer 26

chronic inflam of the airways - atopic asthma - most common type - non-atopic asthma - idiopathic, perhaps viral - drug induced asthma - aspirin sensitivity with nasal polyps - occupational asthma - fumes, dusts, gases

Question 27

what is the 2 wave reaction?

Answer 27

early: bronchocontriction, mucus production and vasodilation late: inflam, active eosiophils, neutrophils, epithelial cells and leukocytes

Question 28

recurrent attacks lead to what?

Answer 28

bronchial wall remodelling - hypertrophy of SM and glands - inc vascularity and subepithelial collagen

Question 29

emphysema: types?

Answer 29

centriacinar panacinar distal acinar irregular

Question 30

what are the genetic factors that play a role in emphysema? what also contributes to emphysema?

Answer 30

polymorphisms in response to injury enzymes: -alpha 1 antitrypsin def polymorphism in MMP expression -high MMP 9 and 12 Toxin exposure also contributes

Question 31

chronic bronchitis is associated with what two main symptoms

Answer 31

``` hypersecretion of mucous (hypertrophy of glands) airway obstruction (due to mucous plugs and fibrosis) ```

Question 32

bronchiectasis is what? what are the predisposing conditions?

Answer 32

dilation of the bronchioles and bronchi - bronchial obstruction - hereditary conditions (CF, immunodef, kartagener syndrome) - necrotizing/ suppurative pneumonia

Question 33

what is the general pathogenesis of bronchiectasis?

Answer 33

obstruction and chronic persistent infections

Question 34

diffuse alveolar damage is a histological pattern of what condition? This condition is formed by two mechanisms

Answer 34

Acute respiratory distress syndrom (ARDS) formed by - direct lung injury - pneumonia, aspirations, hemorrhage - indirect lung injury - sepsis, shock, etc damage will cause inc permiability of vessels, alveolar flooding, loss of diffusion capacity and surfactant abnormalities

Question 35

ARDS has two morphological stages

Answer 35

acute phase - dark, heavy, congested lungs filled with exudate. hyaline membrane formation, organized phase - proliferation of type II pneumocytes, organization of fibrin exudate

Question 36

pneumoconiosis is due to what and what are the three most common causative agents?

Answer 36

- caused by inhalation of dust | - coal, silica, and asbestos

Question 37

What particle size is most dangerous and why?

Answer 37

1-5 micrometers because they get lodged in the bifurcations. larger particles are cleared away, smaller ones act like gases and move in/out

Question 38

coal dust pneumoconiosis has 3 different morphologies

Answer 38

- anthracosis - simple coal workers pneumoconiosis - complicated coal workers pneumoconiosis

Question 39

simple coal workers pneumoconiosis is characterized by what?

Answer 39

Coal macules - coal laden macrophages | coal nodules- coal macules with collagen

Question 40

complicated coal workers pneumoconiosis is generally what?

Answer 40

progression of simple coal workers pneumoconiosis that needs years to develop black scar lesions with dense collagen. causes pulmonary disfunction, HT and cor pulmonale

Question 41

silicosis is associated with what actions

Answer 41

sandblasting, rock-mining, roofing. these actions allow silica crystals to be inhales and phagocytosed by pulmonary macrophages, causing fibrosis

Question 42

what is characteristic of silicosis?

Answer 42

silicotic nodules - concentrically arranged collagen fibers (whorled appearance) These eventually join together to form a large scar

Question 43

asbestosis is associated with which health problems?

Answer 43

- pulmonary interstitial fibrosis (asbestosis) - fibrous plaques - pleural effusions (due to inflam) - bronchogenic carcinoma (or other primary lung cancers) - mesothelioma - laryngeal carcinoma

Question 44

asbestos is carcinogenic how?

Answer 44

it can be a tumor initiator, promoter because it can even absorb harmful carcinogens in tobacco smoke

Question 45

what is the anatomical fibrosis progression is asbestosis, silicosis, and CWP?

Answer 45

asbestosis starts in the lower lobes and moves up silicosis and CWP moves down from the upper lobes

Question 46

what is the most common manifestation of asbestosis?

Answer 46

pleural plaques