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Respiratory System > 10. Sensory Aspects of Respiratory Disease > Flashcards

10. Sensory Aspects of Respiratory Disease Flashcards

1
Q

What is the difference between a symptom and a sign?

A
  • Symptom - abnormal or worrying sensation that leads the person to seek medical attention
  • Sign - an observable feature on physical examination of the patient
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2
Q

How do people interpret sensations?

A
  • Sensory stimulation
  • Sensory transducer
  • Excitation of sensory nerve
  • CNS creates a sensory impression (neurophysiology)
  • Brain interprets the information - sensation (behavioural psychology)
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3
Q

What is a cough?

A

• Crucial defence mechanism protecting the lower respiratory tract from
- inhaled foreign material
- excessive mucus secretion
• Secondary to mucociliary clearance (important when this function is impaired)

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4
Q

Describe the expulsive phase of cough?

A
  • Mucus gets to large airways
  • High velocity airflow generated
  • Expels mucus or foreign material
  • Facilitated by mucus secretion and bronchoconstriction
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5
Q

Where are nerve terminals located in the lungs at a microscopic level?

A
  • Surface of the epithelium

* Well placed to sense the external environment

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6
Q

Where are cough receptors located throughout the lungs?

A
  • Most - posterior wall of the trachea
  • Main carina (ridge between division of bronchi)
  • Common at branching points
  • Larynx, pharynx and external auditory meatus
  • Diaphragm, pleura, pericardium, stomach
  • Absent beyond the bronchioles
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7
Q

What are the 3 main types of cough receptors?

A
  • Slow adapting stretch receptors
  • Rapidly adapting stretch receptors
  • C-fibre receptors (stimulated by chemicals)
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8
Q

Which nerve do all sensory nerves from the airways pass through to get to the brain?

A
  • Vagus nerve

* Cranial Nerve X

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9
Q

What is capsaicin?

A
  • Stimulus to sensory nerves (activate nociceptors through TRPV1 receptors)
  • Burning sensation
  • No affect on stretch receptors
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10
Q

What is the main stimulus for the stretch receptors?

A

Inflation

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11
Q

What affect does an increase in tracheal pressure have on cough receptors?

A
  • Slow adapting stretch receptors are stimulated
  • Rapidly adapting stretch receptors stop firing

(most likely to be involved in coughing)

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12
Q

Describe the C-fibre receptors and how they work

A

• Free nerve endings
• Small unmyelinated fibres - slow conduction
• Present in upper airways (down to bronchi)
• Responds to chemical irritant stimuli and inflammatory mediators
• Release neuropeptide inflammatory mediators:
- Substance P
- Neurokinin A
- Calcitonin Gene Related Peptide

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13
Q

Describe the rapidly adapting stretch receptors and how they work

A
  • Mechanoreceptor
  • Myelinated - conduct quickly
  • Present in upper airways (down to bronchi)
  • Mechanical, chemical irritant stimuli, inflammatory mediators
  • Rapid response to hyperinflation
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14
Q

Describe the slowly adapting stretch receptors and how they work

A
  • Mechanoreceptor
  • Myelinated - conduct quickly
  • In airway smooth muscle
  • Predominantly in the trachea and main bronchi
  • Slowly and rapidly adapting s
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15
Q

What are mechanosensors activated by?

A
  • Mechanical displacement

* Citric acid

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16
Q

What are nociceptors activated by?

A
  • Capsaicin
  • Bradykinin
  • Citric Acid
  • Cinnamaldehyde
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17
Q

What is TRPV1, TRPA1 and B2 present on?

A

Nociceptors

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18
Q

How is the sensory information from a cough stimulus processed?

A
  • Vagus nerve => brainstem => cough centre
  • Consists of nucleus tractus solitarius - neurones connected to the medullar cough pattern generator
  • This stimulates various muscles to produce the cough
  • Cerebral cortex also involved
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19
Q

What happens to the brainstem cough reflex when asleep?

A

Inhibited

also under general anaesthetic

20
Q

What are the 3 phases of a cough?

A
  • Inspiratory phase - trachea opens
  • Glottic closure - increase in intrapulmonary pressure compresses the posterior membrane of the trachea which pushes through and narrows it into a crescent shape
  • Expiratory phase - Pressure in lungs released when glottis opens
21
Q

What is the most common cause of a cough?

A
  • Rhinovirus

* Acute cough (< 3 weeks)

22
Q

What are the most common chronic persistent coughs (>3 weeks)?

A
  • Asthma and eosinophilic-associated
  • Gastro-oesophageal reflux
  • Rhinosinusitis (post-nasal drip)
  • Chronic Bronchitis
  • Bronchiectasis
  • Drugs
23
Q

How can a gastro-oesophageal reflux cause a cough?

A
  • Protons from the stomach can activate the cough receptors

* Activate brainstem cough receptors

24
Q

What is Cough Hypersensitivity Syndrome?

A
  • Chronic cough
  • Cough paroxysms - difficult to control
  • Triggered by: deep breath, laughing, talking, cold air etc.
25
Q

How can you measure the sensitivity of a cough reflex?

A
  • Capsaicin

* Give dilute solution then increase concentration

26
Q

Describe the mechanism that leads to hypersensitivity

A
  • Increased excitability of the afferent nerves by chemical mediators
  • Increase in receptor numbers
  • Increase in neurotransmitter in the brainstem
  • May be an increase in inflammatory mediators - change the reactivity of nerves
27
Q

What symptomatic suppressant therapies act centrally?

A

• Opiates

  • codeine
  • dihydrocodeine
  • pholcodeine
  • dextromethorphan
28
Q

What symptomatic suppressant therapies act peripherally?

A
  • Moguistine

* Levodopropizine

29
Q

Give examples of disease-specific therapies

A
  • Eosinophil associated - inhaled corticosteroids
  • Gastro-oesophageal reflux - proton pump inhibitors, histamine H2 antagonists
  • Rhinosinusitis - topical steroids, antihistamines
  • Bronchiectasis - postural drainage, antibiotics
30
Q

Why are opiates not particularly effective?

A

Work at doses where there are a lot of side-effects (e.g. codeine and morphine)

31
Q

Which nerves are associated with the nose, pharynx, larynx, lungs and chest wall?

A
  • Nose - Trigeminal (V)
  • Pharynx - Glossopharyngeal (IX) and Vagus (X)
  • Larynx - Vagus (X)
  • Lungs - Vagus (X)
  • Chest wall - spinal nerves
32
Q

How are touch and pain differently transmitted?

A

Touch
• travels via Aa and Ab fibres to the dorsal horn
• goes to the controlateral side at the level of the caudal medulla (crosses to other half of body at the brainstem)
Pain
• goes to the contralateral side at the same anatomical level (crosses straight away)

• Both go to the primary somatosensory cortex

33
Q

What is Brown-Sequard Syndrome?

A

• Hemisection of the spinal cord
• If the hemisection is on the left side:
- touch sensation is fine on the opposite side
- pain sensation affected on the other side

34
Q

What are the different types of pain?

A
  • Visceral pain - from internal organs, difficult to localise, fewer afferents
  • Somatic - from skin and subcutaneous tissue, very localised, more afferents
  • Neuropathic
35
Q

Why is it difficult to diagnose visceral pain in the thoracic cavity and chest wall?

A
  • Qualitatively similar

* Exhibit overlapping patterns of referral, localisation and quality

36
Q

What can cause chest pain in the respiratory system?

A
  • Pleuropulmonary disorders - pleural inflammatio
  • Tracheobronchitis - inhalation of irritants
  • Inflammation or trauma to chest wall - rib fracture, muscle injury
  • Referred pain - shoulder-tip pain of diaphragmatic irritation
37
Q

What cardiovascular disorders can cause chest pain?

A
  • MI
  • Pericarditis
  • Dissecting aneurysm
  • Aortic valve disease
38
Q

What gastrointestinal disorders can cause chest pain?

A
  • Oesophageal rupture
  • Gastr-oesophageal reflux
  • Cholecytitis
  • Pancreatitis
39
Q

What psychiatric disorders can cause chest pain?

A
  • Panic disorder

* Self-inflicted

40
Q

What is the clinical dyspnoea scale?

A
  • 0 - breathlessness with strenuous exercise (none)
  • 1 - breathlessness when hurrying or walking up a slight hill (slight)
  • 2 - walks slower than normal, has to stop for breath when walking (moderate)
  • 3 - stops for breath after 100 yards/few minutes on the level (severe)
  • 4 - too breathless to leave house and when dressing (very severe)
41
Q

Briefly describe the Modified Borg Scale

A
  • 0 - 5/6 = nothing to severe
  • 7/8 = very severe
  • 9 = very, very severe
  • 10 = maximal
42
Q

What is air hunger cluster?

A
  • Hunger for more air
  • Suffocation
  • Short of breath
  • Breath feels too small
43
Q

What is work/effort cluster?

A
  • Breathing requires effort
  • Breathing is uncomfortable
  • Breaths feel too large
44
Q

What is tightness cluster?

A
  • Tightness/constriction in chest

* Heaviness in chest

45
Q

How can dyspnoea be treated?

A
  • Add bronchodilators
  • Drugs affecting CNS
  • Lung resection
  • Pulmonary rehabilitation (general fitness)

Respiratory System (18 decks)

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