Week 5 - Respiratory - Non-neoplastic Flashcards
(90 cards)
1
Q
What does the lower airway consist of?
A
Trachea, bronchi, bronchioles, terminal bronchioles, alveoli
2
Q
Which structures of the respiratory system have cartilage in the wall?
A
Trachea
Bronchi
3
Q
Which structures of the respiratory system have smooth muscle in the wall?
A
Bronchioles
4
Q
What infections can you get in the respiratory tract?
A
- uri/sinusitis
- flu
- pneumonia
5
Q
What restrictive disorders may occur in the respiratory tract?
A
- chest wall abnormalities
- connective tissue disorders
- pneumoconiosis
6
Q
What obstructive disorders may occur in the respiratory tract?
A
- COPD (bronchitis/emphysema)
- asthma
- bronchiectasis
7
Q
What vascular disorders may occur in the respiratory tract?
A
- pulmonary oedema
- pulmonary embolism
8
Q
What expansion disorders may occur in the respiratory tract?
A
- atelecasis
- pneumothorax
9
Q
What is the definition of an infection of the upper airway?
A
Acute inflammatory process that effects mucous membranes of the respiratory tract
10
Q
What infections can occur acutely in the upper airways?
A
Rhinitis
Laryngitis
Tonsillitis
Sinusitis
11
Q
What are the symptoms of an upper airway infection
A
Malaise
Headache
Sore throat
Discharge
12
Q
What is the aetiology (cause) of upper airway infections?
A
- commonly viral (attaches to mucosa, invades the tissue, causes necrosis, inflammation and swelling - narrows airways - spreads along mucosa)
- can get secondary bacterial infection
13
Q
Why might a secondary bacterial infection occur after a viral infection of the upper airways?
A
-bacteria penetrate the damages mucous membranes - causing secondary bacterial infection
14
Q
Name an infection of the lower airways?
A
Pneumonia
15
Q
What is the definition of a lower airway infection (pneumonia)?
A
Inflammation of the lung parenchyma (the lung itself)
Consolidation (hardening) of the affected part
Exudate with inflammatory cells and fibrin in the alveolar air spaces
16
Q
What are the causes of infections in the lower airways (pneumonia)?
A
Infectious agents
Inhalation of chemicals
Chest wall trauma
17
Q
List the types/settings of pneumonia
A
- Community acquired
- Hospital acquired
- Aspiration pneumonia
- Chronic pneumonia
- Necrotising pneumonia and lung abscesses
- Pneumonia in the immunocompromised host
18
Q
What are the clinical features of pneumonia?
A
- fever
- rigours
- SOB
- pleuritic chest pain (pain on breathing)
- purulent sputum
- cough
19
Q
Discuss community acquired pneumonia and what causes it
A
-relatively common, esp. in elderly population
- strep pneumoniae = most common organism
- haemophilus influenzae
- staph aureus - complicates viral infection and in IV drug users
-lobar or bronchopneumonia
20
Q
Discuss hospital acquired pneumonia and what causes it
A
AKA - nosocomial pneumonia
- any pneumonia contracted by patient at least 48-72 hrs after admission
- usually bacterial-gram neg bacilli and staph aureus
- severe - can be fatal - most common death cause in ITU
21
Q
What is the other name for hospital acquired pneumonia?
A
Nosocomial pneumonia
22
Q
What are the symptoms of hospital and community acquired pneumonia?
A
Fever
Increased white cell count
Cough with purulent sputum
Chest X-ray changes
23
Q
Discuss aspiration pneumonia and what causes it
A
- develops after inhalation of foreign material
- elderly, strokes, dementia, anaesthetic more prone to develop aspiration
- usually right middle and right lower lobe
- oral flora +- other bacteria
24
Q
What is obstructive respiratory disease?
A
- characterised by partial or complete obstruction at any level from the trachea to respiratory bronchioles
- pulmonary function test - limitation of maximal airflow rate during forced expiration (FEV1 - forced expiratory volume)
25
What is restrictive respiratory disease?
- characterised by reduced expansion with decreased total lung capacity
- FVC (forced vital capacity) is reduced - amount of air that can be blown out after maximal inspiration
26
Name some obstructive diseases
Asthma
COPD
Bronchiectasis
27
What does the upper airway consist of?
Nose, accessory air sinuses, nasopharynx, larynx
28
What is emphysema?
COPD - obstructive disease
Irreversible enlargement of the air spaces distal to the terminal bronchioles - destruction of their walls with out obvious fibrosis
29
What are the types of emphysema a person can get?
Centriacinar
Panacinar
Paraseptal
Irregular
30
Explain the pathogenesis of emphysema
- mild chronic inflammation throughout airways
- protease - antiprotease imbalance hypothesis
- imbalance of oxidants and antioxidants
- role of smoking and genetics
31
Explain the morphology of emphysema
- Voluminous lungs
- large alveoli
- large apical bullae or blebs
32
What are the symptoms of emphysema?
- dyspnoea, cough, wheezing, weight loss
- expiratory airflow limitation (pink puffers)
- death due to cor pulmonale
- congestive heart failure, pneumothorax
33
What is chronic bronchitis?
COPD - obstructive disease
Persistent cough with sputum production, for at least 3 months in at least 2 consecutive years, without any other identifiable cause
34
What may cause chronic bronchitis?
- long-standing irritation by inhaled substances (e.g. Tobacco smoke, dust from grain, cotton, silica)
- hypertrophy of sub mucosal glands in trachea and bronchi, increase in goblet cells
- mucus hypersecretion and alterations in the small airways - chronic airway obstruction
35
Explain the morphology of chronic bronchitis
- mucous membrane hyperaemia (excess of blood vessels), swelling, oedema
- excessive mucous/mucopurulent excretions
- narrowing of bronchioles due to mucus plugging, inflammation and fibrosis
- may cause obliteration in severe cases
36
What are the symptoms/clinical course of chronic bronchitis?
- persistent cough, production of sputum
- dyspnoea on exertion
- hypercapnia (CO2 retention), hypoxemia (low blood O2 conc.), mild cyanosis
- leads to cor pulmonale, cardiac failure, may cause atypical metaplasia/dysplasia
37
What is cor pulmonale?
abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels
38
What is asthma?
- Chronic inflammatory disorder of the airways
- recurrent episodes of wheezing, breathlessness, chest tightness and cough, particularly at night and/or early in the morning
- widespread but variable bronchi obstruction and airflow limitation
- partly reversible (treatment)
39
What are the hallmarks of asthma?
- increased airway responsiveness
- episodic bronchoconstriction
- inflammation of bronchial walls
- increased mucous secretion
40
What are the two types of asthma?
Intrinsic
Extrinsic
41
What is extrinsic asthma?
- response to inhaled antigen - atopic, occupational
| - hypersensitivity, IgE mediated
42
What is intrinsic asthma?
-non-immune mechanisms - cold, exercise, aspirin
43
What happens in an early phase reaction of asthma?
Bronchoconstriction, increased mucous production, vasodilation, increased vascular permeability
44
What happens in a late phase reaction of asthma?
Inflammation, epithelial damage, more bronchoconstriction
45
Explain the morphology of asthma
- lung over inflation and small areas of atelectasis
- thick mucus plugs in bronchi and bronchioles
- airway remodelling
46
What are the symptoms/clinical course of asthma?
- chest tightness, wheezing, dyspnoea, cough +\- sputum
- status asthmaticus
- increase in airflow obstruction, difficulty with exhalation
47
What is bronchiectasis?
Permanent destruction and dilation of the airways associated with severe infections or obstructions
48
What is the aetiology/ what can cause bronchiectasis?
CF, kartageners
post infectious: TB, measles, bronchial obstruction e.g. TB/FB
49
What is the morphology of bronchiectasis?
Dilated, inflamed airways
50
What are the symptoms/is the clinical course of bronchiectasis?
Persistent cough, purulent sputum +++, haemoptysis (coughing of blood from below the glottis)
51
How is a restrictive lung disease characterised?
- reduced expansion with decreased total lung capacity
- FVC (forced vital capacity) is reduced - amount of air that can be blown out after maximal inspiration
- heterogeneous group of diseases
- characterised by inflammation and fibrosis of the pulmonary connective tissue (e.g. interstitium of the alveolar walls)
52
What is the morphology of restrictive lung disease?
- X-ray- bilateral infiltrative lesions - small nodule, irregular lines, ground glass
- scarring and gross destruction of the lung - end stage/honeycomb lung
53
What are the clinical features of restrictive lung disease?
- dyspnoea, tachypnoea, end-inspiratory crackles
- eventual cyanosis, without wheezing
- reduction in gas diffusing capacity, lung volume and compliance
- may lead to secondary pulmonary hypertension and right sided heart failure with cor pulmonale
54
Name some vascular disorders to do with the lungs
```
Pulmonary embolism
Pulmonary oedema
Haemodynamic oedema
Oedema due to alveolar injury
Oedema of undetermined origin
```
55
What is a pulmonary embolism?
Blockage of a main or branch pulmonary artery by an embolus
| -usual source of emboli are deep venous thrombi of the leg (95%)
56
What is the pathophysiology of a pulmonary embolism?
- respiratory compromise
| - haemodynamic compromise
57
What is the morphology of a pulmonary embolism?
- central/peripheral emboli
- pulmonary haemorrhage
- pulmonary infarction
58
What is the clinical course of a pulmonary embolism?
- abrupt onset of pleuritic chest pain
- SOB
- hypoxia
- increased pulmonary vascular resistance -right ventricular failure
59
What is pulmonary oedema?
Accumulation of fluid in the air spaces and parenchyma of the lungs
60
What is the morphology of pulmonary oedema?
- initial fluid accumulation in basal regions - dependant oedema
- engorged alveolar capillaries, intra-alveolar granular pink precipitate
- alveolar microhaemorrhages, haemosiderin-laden macrophages
- heavy, wet lungs
61
What are the clinical features of pulmonary oedema?
- SOB
- pink, frothy sputum
- characteristic CXR findings
62
What may haemodynamic oedema cause?
- increased venous pressure e.g. left ventricular failure
- decreased oncotic pressure e.g. nephrotic syndrome
- liver failure
63
What may cause oedema due to alveolar injury?
- infections
| - shock/trauma
64
What may cause oedema of an undetermined origin?
-neurogenic/high altitude
65
Name some lung expansion diseases
Pneumothorax
Atelectasis
66
What is a pneumothorax?
- air in the pleural cavity
- collapsed lung
-Associated with emphysema, asthma, TB, trauma, idiopathic
67
What is atelectasis?
- incomplete expansion of lungs
- reduces oxygenation and predisposes to infection
- reversible
68
Name the 2 types of respiratory failure
Type 1 - hypoxia with normal or low PCO2
Type II - hypoxia with high PCO2
69
What can cause type 1 - hypoxia with a normal or low PCO2?
- pneumonia
- pulmonary oedema
- asthma
- PE
- pulmonary fibrosis
- ARDS
70
What can cause type II - hypoxia with high PCO2?
- asthma, COPD, OSA
- reduced respiratory drive
- neuromuscular disease
- thoracic wall disease e.g. kyphoscoliosis
71
How is a restrictive lung disease characterised?
- reduced expansion with decreased total lung capacity
- FVC (forced vital capacity) is reduced - amount of air that can be blown out after maximal inspiration
- heterogeneous group of diseases
- characterised by inflammation and fibrosis of the pulmonary connective tissue (e.g. interstitium of the alveolar walls)
72
What is the morphology of restrictive lung disease?
- X-ray- bilateral infiltrative lesions - small nodule, irregular lines, ground glass
- scarring and gross destruction of the lung - end stage/honeycomb lung
73
What are the clinical features of restrictive lung disease?
- dyspnoea, tachypnoea, end-inspiratory crackles
- eventual cyanosis, without wheezing
- reduction in gas diffusing capacity, lung volume and compliance
- may lead to secondary pulmonary hypertension and right sided heart failure with cor pulmonale
74
Name some vascular disorders to do with the lungs
```
Pulmonary embolism
Pulmonary oedema
Haemodynamic oedema
Oedema due to alveolar injury
Oedema of undetermined origin
```
75
What is a pulmonary embolism?
Blockage of a main or branch pulmonary artery by an embolus
| -usual source of emboli are deep venous thrombi of the leg (95%)
76
What is the pathophysiology of a pulmonary embolism?
- respiratory compromise
| - haemodynamic compromise
77
What is the morphology of a pulmonary embolism?
- central/peripheral emboli
- pulmonary haemorrhage
- pulmonary infarction
78
What is the clinical course of a pulmonary embolism?
- abrupt onset of pleuritic chest pain
- SOB
- hypoxia
- increased pulmonary vascular resistance -right ventricular failure
79
What is pulmonary oedema?
Accumulation of fluid in the air spaces and parenchyma of the lungs
80
What is the morphology of pulmonary oedema?
- initial fluid accumulation in basal regions - dependant oedema
- engorged alveolar capillaries, intra-alveolar granular pink precipitate
- alveolar microhaemorrhages, haemosiderin-laden macrophages
- heavy, wet lungs
81
What are the clinical features of pulmonary oedema?
- SOB
- pink, frothy sputum
- characteristic CXR findings
82
What may haemodynamic oedema cause?
- increased venous pressure e.g. left ventricular failure
- decreased oncotic pressure e.g. nephrotic syndrome
- liver failure
83
What may cause oedema due to alveolar injury?
- infections
| - shock/trauma
84
What may cause oedema of an undetermined origin?
-neurogenic/high altitude
85
Name some lung expansion diseases
Pneumothorax
Atelectasis
86
What is a pneumothorax?
- air in the pleural cavity
- collapsed lung
-Associated with emphysema, asthma, TB, trauma, idiopathic
87
What is atelectasis?
- incomplete expansion of lungs
- reduces oxygenation and predisposes to infection
- reversible
88
Name the 2 types of respiratory failure
Type 1 - hypoxia with normal or low PCO2
Type II - hypoxia with high PCO2
89
What can cause type 1 - hypoxia with a normal or low PCO2?
- pneumonia
- pulmonary oedema
- asthma
- PE
- pulmonary fibrosis
- ARDS
90
What can cause type II - hypoxia with high PCO2?
- asthma, COPD, OSA
- reduced respiratory drive
- neuromuscular disease
- thoracic wall disease e.g. kyphoscoliosis
