The upper respiratory tract is responsible for ___, while the lower respiratory tract is responsible for ___.
The upper respiratory tract is responsible for conducting air, while the lower respiratory tract is responsible for gas exchange.
The cartilage rings of the trachea are responsible for what?
They prevent the collapse of the trachea and keep the airway open even with the pressure changes.
What diagnostic test can be used for patients with chronic pulmonary disease?
An exercise tolerance/stress test
What diagnostic test tests pulmonary function by looking at the pulmonary volumes and airflow times?
Spirometry
What diagnostic test can check the site for lesions or bleeding?
A bronchoscopy
Sneezing and coughing are both general manifestations. What are their purposes?
Sneezing is a reflex response when there is irritation in the upper respiratory tract. Coughing can be a result of nasal discharge dripping down into the oropharynx and also be caused by inhaled irritants.
Describe the different types of sputum?
Yellowish-green, clouds and thick: bacterial infection
Rusty/dark-coloured: pneumococcal pneumonia
Purulent with foul odor: bronchiectasis
Thick, sticky: asthma or cystic fibrosis
Blood tinged: chronic cough, tumor or TB
Hemoptysis: blood-tinged, frothy --> pulmonary edema
What is the normal breathing rate?
Eupnea - 10-18 per minute and is effortless
What type of breathing pattern is typical of acidosis or following strenuous exercise?
Kussmaul respirations - deep and rapid, "air hunger"
What does wheezing and stridor often indicate?
Wheezing (whistling) indicate obstruction in the small airways. Stridor usually indicates upper respiratory airway obstruction.
Describe the different types of breath sounds.
Rales - light bubbly or crackling w/ serous secretions
Rhonchi - deeper/harsher sounds w/ thicker mucus
Absence - no sound from non-aeration or collapse of sounds
Severe dyspnea may present with:
- flaring of nostrils
- using accessory respiratory muscles
- retraction (pulling in) of the muscles between or above the ribs
Orthopnea is usually caused by ___.
pulmonary congestion
What are clubbed fingers a result of?
Chronic hypoxia associated with respiratory or cardiovascular diseases.
What do hypoxemia and hypocapnia mean?
Hypoxemia is an inadequate amount of O2 in blood. Hypercapnia is an increased CO2 in the blood.
What is the difference between a LAV and inactivated vaccine?
LAV (live attenuated) - vaccine created by reducing virulence of a pathogen (where it's alive).
Inactivated - made from microorganisms where it' sbeen killed. Not guaranteed to cause an immune response.
What infectious agent causes bronchiolitis?
- respiratory synctial virus (RSV)
What can rsv cause in bronchiolitis and what are its signs and symptoms?
- necrosis
- inflammation in the bronchioles --> edema
- obstruction of small airways
Signs and symptoms:
- wheezing
- dyspnea
- rales
- cough
- fever
Pneumonias are classified by:
- causative agent (viral, bacterial, fungal)
- location of infection (both lungs, or consolidated)
- pathophysio. changes
- epidemiological data (nosocomial, community)
What is lobar pneumonia (answer based on classification)?
Agent: usually streptococcus pneumoniae
Location: all or one of the lobes
Pathophysio: sudden and acute, inflammation and vascular congestion from the exudate formed in the alveoli --> interferes with O2 diffusion. Pleuritic pain.
What is broncho-pneumonia (answer based on classification)?
Agent: several, often bacterial; Staph. A., Haemophilius influenzae, E. coli.
Location: both lungs, usually lower
Pathophysio: exudate forms in alveoli interfering with O2 diffusion.
What makes primary atypical pneumonia from the other two types?
Primary can be bacterial or viral, not just bacterial. Because of the inflammation of the interstitial tissue it tends to produce nonproductive cough (because the fluid isn't in the alveoli and has no way of being relieved). It can also manifest differently, meaning we can feel fine, but the other two are more serious (hospitalized).
What is pneumocystis carinii pneumonia?
A type of atypical pneumonia which is caused by a fungus. Once inhaled it causes necrosis and insterstitial inflammation. The alveoli then fill with exudate and fungi. This is a serious infection for immunocompromised individuals.
How does COVID-19 differ from SARS?
Covid-19 is more severe than SARS and people need to be hospitalized more. True or false?
False; Covid-19 (20%) for hospitalizations and SARS is 20-30%. SARS also has a higher mortality rate.
COVID-19 is caused by ___.
SARS-CoV-2 virus
What organism is responsible for tuberculosis?
Myocobacterium tuberculosis.
Tuberculosis affects the lungs, but can affect other organs as well. True or false?
True.
Why is tuberculosis so difficult to treat?
- bacteria is resistant to many disinfectants
- survives in dried sputum
- normal neutrophil response doesn't occur
- immunity works slowly, allowing the bacteria to proliferate
Describe the first stage of tuberculosis (primary infection).
When the organism first enters the lungs. Inflammation occurs and initiates a type IV cell-mediated hypersensitivity (delayed) reaction. WBCs clump together forming a tubercle containing the organism --> lesions in the lungs which will be walled off by fibrous tissue (Ghon complexes).
Describe the secondary stage of tuberculosis (re-infection).
When the individual has the infection, but is latent. This is due to the organism being hidden in the tubercles and are reactivated. Multiplication --> necrosis of lung tissue. Eventually a cavity will open up in the lungs (cavitation) which will erode the bronchi and blood vessels. The bacteria can exit the lungs and enter other organs from the cavities.
The secondary stage of tuberculosis can occur when:
patient's cell-mediated immunity is impaired
- stress
- malnutrition
- HIV
- age
How is tuberculosis diagnosed?
- tuberculin skin test
- staining sputum test
- CT scan
- sputum culture and sensitivity
What is cystic fibrosis?
An inherited disorder in kids. Exocrine glads create sticky, tenacious mucus which obstructs the airflow in the bronchioles. This causes air to be trapped in the lungs which will eventually cause the collapse of the lung(s).
Name some signs and symptoms of cystic fibrosis.
- meconium ileus (small intestine is blocked by mucus at birth)
- salty skin
- signs of malabsorption (steatorrhea, abdo. distention)
- chronic cough and resp. infections
What are the treatment methods of cystic fibrosis?
- replacement therapy for pancreatic enzymes
- well-balanced diet (^protein, low fat, vit. supplements)
- intensive chest physiotherapy (for removal of tenacious mucus)
- humidifiers and bronchodilators
Adenocarcinomas and bronchoalveolar cell carcinomas are found on the ___.
periphery of lungs.
What is small cell/oat cell cancer?
A rapidly growing cancer found in the major bronchus. It's highly invasive and spreads early.
What are large cell carcinomas (of the lung)?
Carcinomas consisting of undifferentiated large cells that grow rapidly and spread early. Usually found on the periphery of lung.
What is mesothelioma?
An aggressive and deadly cancer. Pleural mesothelioma most often affects the pleura of the lungs.
Name some effects of lung tumors.
- abnormal breath sounds and dyspnea (from obstruction of bronchus)
- cough, hemoptysis (from the inflammation and bleeding)
- pleural effusion (^fluid in pleura)
- pneumothorax
- paraneoplastic syndrome
What is aspiration?
The passage of food, fluid, emesis and other foreign material into the trachea and lungs.
What are some potential complications of aspiration?
- penumonia (inflammation --> gas diffusion is impaired)
- respiratory distress syndrome
- pulmonary abscess (from microbes in the aspirate causing an infection)
What is obstructive sleep apnea (OSA)?
When the pharyngeal tissue collapses during sleep --> random stops of breathing --> not as much O2 received during sleep.
What are the treatment options for OSA?
- CPAP (continuous positive airway pressure pump)
- Oral appliances that reduce collapse of pharyngeal tissue.
What is asthma?
Disease that involves periodic episodes of severe and reversible bronchial obstruction in people with hypersensitive/hyperresponsive airwars.
Describe the two types of asthma.
Extrinsic: acute episodes triggered by type I hypersensitivity reactions (typical allergic reactions)
Intrinsic: onset during adulthood, where the tissue in airway initiates episode.
Describe the pathophysiological changes during an acute episode of asthma (three changes).
- inflammation of the mucosa with edema
- contraction of smooth muscle (bronchoconstriction)
- increased secretion of thick mucus
These create partially or totally obstructed airways and interfere with airflow and O2 supply.
If severe enough asthma can lead to:
- respiratory alkalosis (^hyperventilation to compensate for lack of O2 from obstructed airways)
- respiratory acidosis (from trapped air; CO2 which is acidic can't leave causing the body to be more acidic)
- severe respiratory distress (hypoventilation --> hypoxemia and respiratory acidosis)
What is status asthmaticus?
A persistent severe attack of asthma, which is a medical emergency. Fatal because of severe hypoxia and acidosis.