Gen Path - Class 12

Front 1

What are the three classifications of respiratory diseases?

Back 1

(1)Acute vs. chronic, (2)Obstructive vs. restrictive, (3)Infectious vs. non-infectious

Front 2

What are 10 pulmonary s/sx of respiratory diseases.

Back 2

(1)Hypoxemia, (2)Atelectasis, (3)Chest pain, (4)Clubbing, (5)Cough, (6)Cyanosis, (7)Dyspnea, (8)Hemothorax, (9)Pneumothorax, (10)Pyothorax

Front 3

Describe hypoxemia.

Back 3

Deficient oxygenation of arterial blood. Most common condition caused by lung dz or injury. Not to be confused with hypoxia – diminished oxygen to various body tissues

Front 4

Describe atelectasis.

Back 4

Collapsed or airless condition of lung.

Front 5

Describe chest pain.

Back 5

Usually localized substernal or across the chest, over involved lungs. Can radiate tp neck, scaps, shoulders, down medial aspect of the arm. May be caused by parietal pleural irritation, made worse with respiration (particularly Inspiration). Better lying on the affected side = autosplinting

Front 6

Describe clubbing.

Back 6

Enlarged terminal phalanx of the fingers and toes – loss of the normal angle between the nail and the nail bed. Chronically decreased tissue perfusion (lung CA, CF, bronchiectasis, pulm fibrosis). [Not always respiratory dz - can also be heart dz, PVD, and liver or GI disorders]

Front 7

Describe cough.

Back 7

Different cough characteristics can help with dx. Persistent, dry: tumour, congestion, hypersensitivities/allergies, drug side effects.

Productive & purulent: infection (viral/bacterial).

Productive & non-purulent: irritation.

Hemoptysis (coughing up blood): infection, inflammation, abscess, tumour, infarction, trauma

Front 8

Describe cyanosis.

Back 8

Bluish colour of skin or mucous membranes in response to low oxygenation saturation of arterial blood, and total amount of circulating hemoglobin. Central -- lips, oral mucous membranes, conjunctivae (R--L shunts, pulm dz). Peripheral -- nail beds, fingers, toes and nose (cold external temperature, anxiety, heart failure, shock).

Front 9

Describe dyspnea.

Back 9

Difficult breathing or shortness of breath (SOB). Inadequate ventilation or perfusion. Orthopnea = dyspnea when lying down (dt abdominal pressure, edema). Usually indicates hypoxemia.

Front 10

Describe hemothorax.

Back 10

Presence of blood in the plural cavity. eg. TB, pneumonia

Front 11

Describe pneumothorax.

Back 11

Presence of air or gas in the pleural cavity

Front 12

Describe pyothorax.

Back 12

Accumulation of pus in the thoracic cavity (form of empyema)

Front 13

What are seven altered breathing patterns and sounds?

Back 13

(1)Apnea, (2)Hyperventilation, (3)Hypoventilation, (4)Rales, (5)Rubs, (6)Wheezing, (7)Stridor

Front 14

Describe apnea.

Back 14

Cessation of breathing. “Apneustic” breathing: episodes of short, shallow expiration, with gasping & prolonged inspiration

Front 15

Describe hyperventilation.

Back 15

Abnormally prolonged and deep breathing

Front 16

Describe hypoventilation.

Back 16

Reduced ventilation of alveoli -- increased in arterial CO2

Front 17

Describe rales.

Back 17

Crackling sounds usually heard on inspiration (rice krispies) (pneumonia)

Front 18

Describe rubs.

Back 18

Grating, tearing or rubbing sound (velcro) (inflammation)

Front 19

Describe wheezing.

Back 19

(Rhonchi): breathing w/ a rasp or whistling sound. Constriction or obstruction of throat, pharynx, trachea or bronchi.

Front 20

Describe stridor.

Back 20

Shrill, harsh sound heard during inspiration. Generally indicates laryngeal obstruction

Front 21

What are two types of infectious & inflammatory disease of the respiratory system?

Back 21

(1)Upper Respiratory Tract (URT), (2)Lower Respiratory Tract (LRT)

Front 22

What are three Upper Respiratory Tract (URT) infections?

Back 22

(1)Rhinitis, (2)Sinusitis, (3)Laryngitis

Front 23

What is the etiology of upper respiratory tract infection?

Back 23

virus, bacteria, fungus, irritant

Front 24

What are 11 clinical manifestations of upper respiratory tract infections?

Back 24

(1)Inflammation, (2)enlarged lymph nodes, (3)loss of voice, (4)sneezing, (5)cough, (6)sore throat, (7)general malaise, (8)fever, (9)chills, (10)lethargy, (11)anorexia

Front 25

Describe acute rhinitis.

Back 25

Common cold – MC of all illnesses – viral (esp adeno viruses).

Symptoms: runny nose, sneezing, nasal congestion, mild sore throat.

Other causes: allergic rhinitis (eg. cats), bacterial infection

Front 26

Describe sinusitis.

Back 26

Inflammation of paranasal sinuses. Often due to pre-existing nasal or dental infections. Can be viral, bacterial or fungal. Sx’s mostly from obstructed drainage + systemic.

Front 27

What are three symptoms of sinusitis?

Back 27

(1)Sinus headaches/pain, (2)Congestion, (3)Systemic symptoms (fever, malaise etc.)

Front 28

Describe laryngitis.

Back 28

Acute inflammation of larynx. Bacteria, viruses, irritants, overuse. Symptoms: Loss of voice/hoarseness, sore/dry throat, cough.

Front 29

What are four lower respiratory tract infections?

Back 29

(1)Pneumonia, (2)Pulmonary Tuberculosis, (3)Lung Abscess, (4)Acute Bronchitis

Front 30

What is pneumonia?

Back 30

inflammation of lung parenchyma (lobar, bronchopneumonia)

Front 31

What is the etiology of pneumonia?

Back 31

Pathogens: virus 50% (often influenza), bacteria 30%, mycobacteria 20%, Pneumoncystis carinii p. opportunistic parasite common w AIDS. Less commonly: inhaled toxins, chemicals, smoke, dust, gas, aspirated food, fluid or vomitus.

Front 32

What is the pathogenesis of pneumonia?

Back 32

First and second lines of defense can’t overcome microorganism -- inflammation and infection result.

Viral: generally mild and self-limiting. ("walking pneumonia"

Bacterial: can be secondary to viral, usually lower lobes, longer to resolve

Front 33

What are eight clinical manifestations of pneumonia?

Back 33

(1)sudden and sharp pleuritic pain, (2)purulent / smelly productive hacking cough, (3)dyspnea or tachypnea (rapid respirations), (4)tachycardia (5)fever, (6)chills, (7)maybe hemoptysis, (8)[recall: elderly may not have fever, May have altered mental status or loss of balance]

Front 34

What is pulmonary tuberculosis?

Back 34

aka consumption – chronic infection by Mycobacterium tuberculosis. Infectious, inflammatory systemic disease (lungs, lymph nodes, bone, kidneys, skin). Granulomas + caseous necrosis -- abscess. World’s highest infectious mortality

Front 35

What the two types of TB?

Back 35

(1)Latent, (2)Active

Front 36

What is latent TB?

Back 36

Harbouring the mycobacterium, but no signs/symptoms

Front 37

What is active TB?

Back 37

Clinical s/sx’s and lab findings

Front 38

What are eight risk factors for TB?

Back 38

(1)HIV, (2)age, (3)overcrowding, (4)drug use, (5)alcohol, (6)infants, (7)immunocompromise, (8)DM

Front 39

What is etiology of TB?

Back 39

Primary: inhalation of tubercle bacillus –prolonged and/or repetitive exposure(Mycobacterium tuberculosis) – usually latent, can be dormant for decades.

Secondary: usually endogenous activation as a result of debility or lowered immune function; occas. exogenous reinfection

Front 40

What are 8 clinical manifestations of TB?

Back 40

(1)No Sx’s for >1 year, then productive cough for >3 weeks (poss blood-streaked), (2)rales, (3)weight loss, (4)fever, (5)night sweats, (6)fatigue, (7)malaise, (8)anorexia

Front 41

How is TB treated?

Back 41

Anti-TB drugs for 6-9 months (non-compliance probs -- must restart if missed 2 weeks) – often a combo of 2 or more drugs.

Front 42

What is the pathogenesis of TB?

Back 42

Initial infection -- epithelial cells encapsulate the bacilli -- forms a tubercle. 2-10 weeks later: cell-mediated immunity kicks in -- activated T-cells lead to granulomas which limit further multiplication.

Organism usually at localized sites.

Front 43

What is the pathogenesis latent and cell-mediated TB?

Back 43

While latent, no clinical symptoms, no detection on x- ray -- only a ✚ skin test -- not contagious.

Cell-mediated immunity not successful… granulomas become necrotic -- produce fibrosis and calcification

Front 44

What is a lung abscess?

Back 44

Localized accumulation of purulent exudate within the lungs. Usually subsequent to pneumonia (esp. Staph) when organisms are aspirated from the oropharynx. Also from aspirated foreign material; alcohol is the most common cause - vomitus

Front 45

What is the etiology of a lung abscess?

Back 45

pyogenic bacteria (eg Staph pnemonia)

Front 46

What is pathogenesis of a lung abscess?

Back 46

A natural defense mechanism leads to consolidation: fluid, pus, and microorganisms fill the alveoli -- necrosis of consolidated tissue may spread to bronchi. Then spreads to other parts of the lung to form cavities.

Front 47

What are eight clinical manifestations of a lung abscess?

Back 47

(1)cough (productive w/ foul smelling sputum), (2)dyspnea, (3)pleuritic chest pain, (4)cyanosis, (5)clubbing, (6)fever, (7)chills, (8)malaise

Front 48

How is a lung abscess treated?

Back 48

Antibiotics, Airway clearance – ie. percussion

Front 49

What is acute bronchitis?

Back 49

Inflammation of the trachea and bronchi. 1-3 weeks, self-limiting, few pulmonary signs

Front 50

What are the risk factors and etiology of acute bronchitis?

Back 50

Second to viral infection or other irritant (smoke, fumes, etc.)

Front 51

What are three clinical manifestations of acute bronchitis?

Back 51

(1)cough, initially dry and irritating, later productive/purulent (if bacterial), (2)sore throat, (3)usually chest pain from coughing

Front 52

What is chronic obstructive pulmonary diseases (COPD)?

Back 52

A group of airflow obstruction disorders: Chronic bronchitis; Obstructive bronchiolitis; Emphysema. Airflow not fully reversible (Especially small airways. Major cause of disability. Most common cause is smoking.

Front 53

What are the two most common conditions that contribute to COPD?

Back 53

(1)Emphysema, (2)Chronic bronchitis

Front 54

What is the etiology of COPD?

Back 54

Smoking

Front 55

What is chronic bronchitis?

Back 55

Chronic productive cough lasting > 3 months/year for 2 consecutive years. Starts in large bronchi…progresses to bronchioles –all airways eventually obstructed, worse with expiration. Expiration often triggers a cough

Front 56

What are five clinical manifestations of chronic bronchitis?

Back 56

(1)persistent cough, (2)sputum, (3)dyspnea, (4)prolonged expiration, (4)recurrent infections (because of impaired ciliary function), (5)cyanosis (“blue bloaters”)

Front 57

What is the pathogenesis of chronic bronchitis?

Back 57

Inflammation and scarring of the bronchial lining -- obstructs air flow -- increased mucous production -- hyper secretion in response to triggers + hypertrophy of mucous-producing cells in bronchi -- hypoxemia -- increased RBC production (polycythemia) -- cyanosis, as well as peripheral edema from subsequent ventricular failure (hence blue bloater)

Front 58

What are two possible outcomes of chronic bronchitis?

Back 58

(1)Pulmonary HTN over time, (2)Possibly Cor Pulmonale

Front 59

What is emphysema?

Back 59

Pathological accumulation of air in tissue – particularly the lungs. Found in most people with COPD.

Front 60

What are the three types of emphysema?

Back 60

(1)Centrilobular, (2)Panlobular, (3)Paraseptal

Front 61

What is centrilobular emphysema?

Back 61

Most Common, destruction of bronchioles, usually upper lung, alveoli intact

Front 62

What is panlobular emphysema?

Back 62

Destroys air spaces of whole acinus, usually lower lung

Front 63

What is paraseptal emphysema?

Back 63

Destroys alveoli in lower lungs

Front 64

What are the risk factors and etiology for emphysema?

Back 64

smoking, hereditary, prolonged respiratory difficulty (i.e. long-term bronchitis)

Front 65

What is the pathogenesis of emphysema?

Back 65

Irreversible destruction of elastin in lungs, which maintains alveolar wall strength -- permanent enlargement of acini -- narrowing/collapse of bronchioles traps air in lungs -- obstruction (from change in tissue, not b/c of mucous) and increased effort to exhale

Front 66

What are six clinical manifestations of emphysema?

Back 66

(1)thin (cachexia), (2)Tachypnea, prolonged expiration, (3)increased respiratory effort -- use of secondary respiratory muscles (barrel chested -- “pink puffer”), (4)depression/anxiety, (5)calloused elbows, (6)cough is uncommon

Front 67

What are six possible outcomes of emphysema?

Back 67

(1)chronic bronchitis, (2)pneumonia, (3)CHF, (4)pulmonary embolism, (5)cardiac complications, (6)CorPulmonale

Front 68

What is asthma?

Back 68

Reversible, obstructive lung disorder with inflammation, and increased smooth muscle reaction to various triggers. Chronic with acute exacerbations.

Front 69

What is the etiology of asthma?

Back 69

Often genetic (atopic and non-atopic). Also multifactorial: biochemical; autonomic; immunologic; infectious; endocrine factors; psychological (stress, extreme emotions).

Front 70

What are the two main categories of asthma?

Back 70

(1)Extrinsic, (2)Intrinsic

Front 71

Describe extrinsic asthma.

Back 71

Allergic/Atopic (IgE). Histamine-mediated (Molds (Aspergillus), Any allergen, Aspirin (or other NSAIDS)).Inorganic chemicals (i.e.coal dust)

Front 72

Describe intrinsic asthma.

Back 72

Non-allergic. Usually adult-onset. Cold air. Exercise. Obesity.

Front 73

What are risk factors for asthma?

Back 73

Young children, premature babies, C-section babies, and overuse of antibiotics in children under 5, industrialized settings (chemical exposure), cold air, overcrowded living conditions, Airtight homes, especially with forced air or gas heat, smoking, dust, mold, pet hair, other allergens, Wine (sulfites and salicylates), Obesity, “hygiene hypothesis": Lack of exposure to allergen triggers, and/or overexposure to cleaning products (chemical trigger)

Front 74

What is the pathogenesis of asthma?

Back 74

Inflammatory response -- inflammatory mediators -- bronchial smooth muscle spasm -- vascular congestion -- increased vascular permeability -- edema -- thick mucous production -- impaired mucociliary function. Also likely involvement of neuroendrocrine system, because of the high prevalence of stress-induced asthma attacks.

Front 75

What are nine clinical manifestations of asthma?

Back 75

(1)sensation of chest constriction, (2)wheezing on inspiration and expiration, (3)non-productive cough at first, Then thick tenacious sputum, (4)tachycardia, (5)tachypnea, (6)dyspnea, (7)cyanosis, (8)pale/moist skin, (9)flaring nostrils

Front 76

What is bronchiectasis?

Back 76

A progressive form of obstructive lung disease, with irreversible destruction and dilation of the airways. Usually assoc’d with chronic bacterial infections that result in chronic inflammation, which causes tissue changes. Considered to be an extreme form of bronchitis.

Front 77

What is the pathogenesis of bronchiectasis?

Back 77

All airways, esp. the small airways – chronic inflammation of the airway walls by mononuclear cells -- result in mucous secretions -- obstruction

Front 78

What is the etiology of bronchiectasis?

Back 78

Any condition producing a narrowing of the lumen of the bronchioles.

Front 79

What are 10 clinical manifestations of bronchiectasis?

Back 79

(1)persistent cough with copious purulent sputum worse in the morning, (2)rhinosinusitis, (3)dyspnea, (4)fatigue, (5)hemoptysis, (6)low grade fever, (7)clubbing, (8)weight loss, (9)weakness, (10)foul breath

Front 80

What is bronchiolitis?

Back 80

‘small airways disease’. Common in young kids (under 2) as a result of a viralURTI.

Front 81

What are four clinical manifestations of bronchiolitis?

Back 81

(1)stuff nose and congestion, (2)runny nose, (3)cough, (4)fever. These symptoms last a day or two and are followed by worsening of the cough and wheezing (high-pitched whistling noises when exhaling)

Front 82

What are two clinical manifestations of sleep apnea?

Back 82

(1)Significant daytime symptoms (most common is intense fatigue no matter how many hours of sleep), (2)Upper airway obstruction while sleeping

Front 83

What is the etiology/risks of sleep apnea?

Back 83

Usually a history of snoring, obesity, < alchohol intake

Front 84

What is the pathogenesis of sleep apnea?

Back 84

Partial of complete pharyngeal collapse

Front 85

What is restrictive lung disease?

Back 85

Any condition that limits lung expansion

Front 86

Pulmonary fxn tests show _________ .

Back 86

DECREASE IN TOTAL LUNG CAPACITY

Front 87

What are two causes of restrictive lung disease?

Back 87

(1)>100 interstitial pulmonary dz’s, (2)extrapulmonary: a)motor nerve pathology (spinal cord injury, ALS, MD, myasthenia gravis, polio), b)musculoskeletal (ankylosing spondylitis, kyphosis, scoliosis, obesity, chest wall injury/deformity), c)Postsurgery complications

Front 88

What are three clinical manifestations of restrictive lung disease?

Back 88

(1)Specific CM’s depend on etiology, (2)Rapid (tachypnea), shallow breathing, (3)Exertional dyspnea, then chronic dyspnea with disease progression

Front 89

What is pulmonary fibrosis?

Back 89

aka interstitial lung dz. Collective term – any dz where ongoing epithelial damage or chronic inflammation of lung tissue leads to progressive scarring = fibrosis.

Front 90

What is the etiology/risk factors of pulmonary fibrosis?

Back 90

(1) idiopathic (most), (2)Second. to TB, systemic sclerosis, adult respiratory distress syndrome, pneumoconiosis, SLE, inhalation of harmful particulates

Front 91

What is the pathogenesis of pulmonary fibrosis?

Back 91

replacement of healthy lung tissue with progressive scarring: via fibroblast + blood vessel proliferation in response to chronic inflammation/irritation -- fibrosis + hypoxia

Front 92

What is systemic sclerosis?

Back 92

Scleroderma– autoimmune connective tissue dz -- XS collagen deposition in skin and organs (esp esophagus, lungs and kidney); skin changes occur before visceral.

Front 93

What are the risk factors and etiology of systemic sclerosis?

Back 93

women of child bearing age; idiopathic (poss mycoplasma or CMV assoc)

Front 94

What is the pathogenesis of systemic sclerosis?

Back 94

(1)T-cells and cytokines cause inflammation –alveolitis and fibrois, (2)Severe thickening & obstruction of vessels -- pulm. Htn & renal failure, (3)Cutaneous fibrosis

Front 95

What is the clinical manifestation of systemic sclerosis?

Back 95

C - calcinosis around cuticles

R - Raynaud’s disease

E - esophageal dysfunction

S - sclerodactyly

T - telangectasia

Front 96

What is the outcome of systemic sclerosis?

Back 96

variable course, but ↑ pulm fibrosis --cor pulmonale. Lung disease is the most common cause of death in SS.