Exam I Flashcards
1
Q
What is the primary function of the lungs
A
Gas Exchange
2
Q
What is the purpose of gas exchange in the lungs
A
Delivery of O2 from air to blood and delivery of CO2 from blood to air
3
Q
Where does gas exchange occur
A
Blood-air barrier in the alveolus
4
Q
Name the two steps in gas exchange
A
Gas delivery (ventilation and perfusion) and transfer across membrane (diffusion)
5
Q
What accommodations does gas exchange need
A
Large airspace and vascular surface areas
6
Q
What are the primary functional/structural units for gas exchange
A
Alverolar parenchyma
7
Q
Does the alveolar parenchyma have a large or small surface area
A
Large surface area
8
Q
What is the mechanical barrier for the upper respiratory tract
A
Mucociliary Clearance
9
Q
What are the components of mucociliary clearance
A
Ciliated cells
Mucus secretion
Mucociliary clearance
10
Q
What is the adaptive immunity of the respiratory defenses
A
(Mucosal-associated lymphoid tissues) MALTs
NALTs
BALTs
T-cells (cytotoxic and T-helper cells)
Immunoglobulins (IgA and IgG from B-cells)
11
Q
Does the respiratory system have adaptive immunity at birth
A
No
Adaptive immunity forms 3-4 weeks of age
Natural exposure
Vaccination
12
Q
What is the nasal airway function
A
Conditioning and filtration
Turbinates
Warming
Humidifying
Mucosa contains leaky capacitance vessels
13
Q
What is the Laryngeal structure and function
A
Maintain airway patency during breathing
Protect airway during swallowing, vomiting, and regurgitation
14
Q
What is the function of the arytenoid cartilages
A
Adduction to close rima glottidis
15
Q
What is the function of the epiglottis
A
Passive coverage of rima glottidis during swallowing
16
Q
Is cough a disease
A
No
17
Q
What is cough
A
Reflex that protects lungs from contaminants
Sign of disease
18
Q
What is the function of a cough
A
Aids in removal of secretions and debris
19
Q
Why does a cough happen
A
When mucociliary clearance is overwhelmed
20
Q
What is the cough neurophysiology of the nose
A
Trigeminal V goes to efferent vagus and phrenic
21
Q
What is cough neurophysiology of the larynx, trachea, bronchi, ear, stomach, pleura
A
Afferent vagus X go to cough centers in medulla
22
Q
What is the cough neurophysiology of the nasopharynx
A
Glossopharyngeal IX which goes to larynx, trachea, bronchi, diaphragm, and respiratory muscles
23
Q
What is the cough neurophysiology for heart and pericardium
A
Phrenic to the larynx, trachea, bronchi, diaphragm, respiratory muscles
24
Q
What is the cough mechanics
A
Deep rapid inspired tidal volume (air into lungs)
Closed glottis, expiratory muscle contraction
Airway pressure forcefully expels air
25
What do you expect to see in a normal bronchoalveolar lavage cytology for both cats and dogs
Macrophages (75%)
Lymphocytes (5-10%)
Neutrophils (5-10%)
Eosinophils (5%)
Epithelial cells (5-10%)
26
What are the consequences of impaired respiratory defenses
Loss of mucociliary clearance
Imparied nasal function
Compromised laryngeal function
Inadequate or impaired immune function
27
What is the directional flow of mucociliary flow in the nasal turbinate
Toward the caudal nasal cavity and into the nasopharynx
28
What is the mucociliary flow when bacteria land in the mucus layer on the trachea
Up along the tracheal mucosa toward the laryngopharynx to be swallowed or expectorated (coughed out)
29
What is the typical presentation of bronchopneumonia
Cranial ventral distribution
30
What pattern is shown here
Alveolar pattern
31
What are the two major causes of bronchopneumonia in small animals
Bacterial pneumonia
Aspiration pneumonia
32
Is bronchopneumonia mutually exclusive
No
33
What are the characteristics of bacterial pneumonia
Deposition of bacteria into alveoli
Decreased host defenses
Penetrated thoracic injury
34
What are common bacterial pathogens in dogs
Staphylococcus
Streptococcus
Enterococcus
E. coli
Bordetella bronchispetica
Pseudomonas
Pasteurella
Bacteroides
35
What are common bacterial pathogens for cats
Staphylococcus
Streptococcus
E. coli
Bordetella bronchispetica
Pseudomonas
Pasteurella
Bacteroides
36
What are the factors that decrease host defenses in bacterial pneumonia
Permit deposition into alveoli
Damage to respiratory epithelium
Immune suppression
Immunodeficiencies
Functional abnormalities
Altered loss of conscious
37
How does aspiration pneumonia happen
Aspiration of gastric contents
38
What are the mechanisms of aspiration pneumonia
Low pH (<2.4)-chemical pneumonitis
Large volumes of fluid
Particulate matter-obstructive and inflammatory pneumonitis
39
What are the three stages of aspiration pneumonia
Phase 1-Airway response
Phase 2- Inflammatory response (neutrophil influx 4-6 hours)
Phase 3- Secondary bacterial colonization (48-72 hours)
40
What are the predisposing factors of aspiration pneumonia
Impairment of airway reflexes
Impairment of lower esophageal sphincter function (NG tube, BOAS, GOLPP, Overfeeding, Ileus)
41
What are the respiratory clinical signs of bronchopneumonia
Moist "crescendo" or "puffing" cough (dogs>cats)
Post-tussive retching
Nasal discharge
Tachypnea->dyspnea
Auscultation-crackles, wheezes
42
What are the systemic clinical signs of bronchopneumonia
Fever
Lethargy
Dehydration
Decreased appetite
43
How do you collect a bronchopulmonary sample
Bronchoalveolar lavage (BAL)
Anesthesia
1-2ml/kg sterile solution
44
What does a BAL sample
Bronchioles
Alveoli
45
What are the complications of BAL
Hypoxemia
Bronchoconstriction and mucus secretion
Laryngeal stimulation and spasm
46
When does bacterial infection occur relative to an aspiration event
Phase 3 (48-72 hours)
47
Should a productive cough be suppressed
No
It should be enhanced, while addressing underlying cause
48
Do radiographs give a definitive answer
No
It narrows down the differential list
49
What do we normally see on normal thoracic radiographs
Cardiac silhouette
Vasculature (Aorta/CVC and pulmonary vessels)
Air-filled lungs
Extrathoracic structures
50
What don't we normally see on thoracic radiographs
Cartilage (bronchial walls)
Pulmonary interstitium
Pleura
51
What pattern is this
Unstructured interstitial pattern
52
What is this pattern
Unstructured interstitial pattern
53
What are the differential diagnoses for unstructured interstitial patterns
Vascular dereangements
Edema (cardiogenic or non-cardiogenic)
Hematogenous pneumonia (Viral, septic)
Pneumonitis (Uremic, toxic)
Hemorrhage
Neoplasia (Lymphoma in dogs)
54
What is the most common cause of unstructured interstitial pattern
Artifact
Expiratory
Underexposure
Obesity
55
What pattern is this
Nodular (structured) interstitial pattern
56
What are the differentials for nodules
Metastatic neoplasia
Granulomatous disease (fungal or parasitic)
57
What is the interpretation principle for nodules
Soft tissue nodules cannot be seen radiographically unless 3 mm or greater in diameter
58
What are the signs of bronchial pulmonary patterns
Bronchial walls are seen due to thickening or surrounding (peribronchial) changes
End on "doughnuts"
Parallel lines 'tram lines'
59
What pattern is this
Bronchial pulmonary pattern
60
What pattern is this
Bronchial pulmonary pattern
61
What is the differential diagnosis of bronchial pulmonary patterns
Lower airway disease
Infectious (bacterial, parasitic)
Inflammatory (bronchitis)
Allergic (Asthma, eosinophilic bronchopneumopathy)
62
What happens when alveoli are filled with something other than air on radiographs?
Soft tissue opacity
63
What are the three hallmarks of alveolar pattern
Air bronchograms
Lobar sign
Soft tissue silhouetting
64
What happens when alveolar pulmonary pattern is present
Alveoli are filled with fluid or tissue
65
What is this pattern
Alveolar pulmonary pattern
66
What pattern is this
Alveolar pulmonary pattern (lobar sign)
67
What pattern is this
Alveolar pattern with lobar sign
68
What is this pattern
Alveolar pattern
69
What is the differential diagnosis of alveolar pattern
Bronchopneumonia
Hemorrhage (trauma, coagulopathy)
Edema (cardiogenic/non-cardiogenic)
Neoplasia
Atelectasis
70
What is this picture showing
Atelectasis
71
What is this picture showing
Atelectasis
72
What are the major cell types of the lower respiratory tract
Progenitor cell
Terminally differentiated cell
Ciliated cells
Non-ciliated cells-Mucus (goblet) cells and club cells
73
What are the 5 major cell types in the alveolar parenchyma
Type I pneumocyte
Type II pneumocyte
Endothelial cells
Fibroblasts
Alveolar macrophages
74
What are progenitor cells
A multipotent cell that further differentiates into specialized cell types
75
What are terminally differentiated cells
Cell that has acquired specialized functions and has irreversibly lost its ability to proliferate
76
What are ciliated cells
Most abundant cell from nasal cavity to bronchi, and large bronchioles
Ciliary movement is synchronized to move the mucus 'escalator'
Terminally differentiated cells
77
What are mucus (goblet) cells
Produce and secrete mucus
Capable of cell division, so can act as progenitor cells
More resistant to injury than ciliated cells
Most numerous in bronchi
78
What are club cells
Important progenitor cells for epithelial repair
Metabolically active cells
Produce surfactant and are source of club cell secretory protein
Line bronchioles
79
What is the site of blood-gas exchange
Alveoli
80
What are type I pneumocytes
Large, flat epithelial cells that cover 95% of the alveolar surface
Terminally differentiated cell
Sensitive to injury
Facilitate gas exchange
Help keep alveolar fluid levels in balance
81
What are type II pneumocytes
Cuboidal epithelial cells
Positioned at corners of alveoli
Progenitor cell
Surfactant production
Replace injured type I cells
Metabolically active cells
82
What is interstitium
Connective tissue that lies in between the principal cells of an organ
83
What is the interstitium of the lung
Consists of the alveolar and interlobular septa
84
What is the interstitial pneumonia
Inflammation or damage affecting alveolar and interlobular septa
85
Explain the pulmonary arterial circulation
Receives entire cardiac output from the right ventricle of heart
High volume, low pressure
Blood supply for alveoli, pleura
86
Explain bronchial arterial circulation
Blood from left ventricle
Arises from the aorta or intercostal arteries or subclavian arteries
Low-volume, high-pressure
Blood supply to bronchi, bronchioles, blood vessels, pleura, interstitium
87
What is bronchopneumonia
Injury or inflammation affecting bronchioles, alveoli
88
What is interstitial pneumonia
Injury or inflammation affecting interstitium (alveolar and interlobular septa)
89
Bronchointerstitial pneumonia
Injury or inflammation affecting bronchioles and interstitium
90
Embolic pneumonia
Injury or inflammation centered on blood vessels
91
What are the routes of entry
Airborne (inhalation)
Hematogenous (circulating blood)
Direct extension (trauma)
92
What are three hallmark signs of pleural effusion
Retraction of lung lobe margins
Leafing of lung lobes
Pleural fissure lines
93
What are responses to injury to the epithelium lining of bronchi and bronchioles
Goblet cell hyperplasia
Squamous metaplasia
Bronchiectasis
Bronchiolitis obliterans
94
What is goblet cell hyperplasia
Chronic injury to bronchial epithelium
Goblet cells proliferate
Produce excessive mucus
95
What is squamous metaplasia
Chronic irritation or injury to bronchial/bronchiolar epithelium
Causes ciliated epithelium to transform into squamous epithelium (metaplasia)
Lose function of mucociliary apparatus
96
What is bronchiectasis/bronchiolectasis
Chronic inflammation and obstruction of the conducting airways leads to permanent dilation of bronchi/bronchioles
Most commonly associated with chronic bacterial bronchopneumonia
97
What is Bronchiolitis Obliterans
Chronic injury to bronchiolar epithelium leads to formation of plug of fibrous tissue in bronchiolar lumen that obstructs it
Common finding in chronic bacterial bronchopneumonia in cattle
98
Gross pattern I: Cranioventral bronchopneumonia
Airborne route of exposure
Inflammation centered on bronchi, bronchioles and alveolar lumens (suppurative)
Firm on palpation
Causes: Bacteria
99
Gross Pattern II: Lobar bronchopneumonia
Entire lobe
Airborne route of exposure
Inflammation centered on bronchi, bronchioles and alveolar lumens (suppurative, fibrinous, or necrotizing)
Firm or consolidated on palpation
Causes: Manheimia hemolytica, aspiration pneumonia
100
Gross Pattern III: Interstitial Pneumonia
Diffuse distribution
Airborne or hematogenous
Inflammation centered on alveolar and interlobular septae
Rubbery on palpation
Causes: Toxins, hypersensitivity reactions, acute respiratory distress
101
What is Bronchointerstitial pneumonia
Gross Pattern III: Interstitial pneumonia
Histologic pattern, NOT a gross pattern
Diffuse distribution
Airborne or hematogenous
Inflammation/injury affecting bronchioles and interstitium
Rubbery on palpation
Causes: Viruses
102
Granulomatous Pneumonia
Gross Pattern III: Interstitial pneumonia
Organisms can't be eliminated by phagocytosis
Airborne or hematogenous
Inflammation is randomly distributed
Macrophages and giant cells form granulomas
Firm nodules on palpation
Causes: Bacteria, fungi
103
Gross Pattern IV: Embolic Pneumonia
Multifocal distribution
Hematogenous route of exposure
Round lesions centered on blood vessels
Variably sized, multifocal, soft to firm nodules on palpation
Causes: bacterial or fungal seeding
104
Gross Pattern V: Airway Disease
Multifocal distribution
Airborne route of exposure
Inflammation centered on bronchi or bronchioles (suppurative, fibrinous, mucoid)
Causes: Asthma
105
What could be a cause of this pattern
Caudodorsal disease
Non-cardiogenic pulmonary edema
Seizure
Electrocution
Near drowning
Upper airway obstruction (strangulation)
106
What pattern is this
Bronchial
107
What patterns is this
Unstructured Interstitial
108
What pattern is this
Structured interstitial
109
What pattern is this
Structured interstitial
110
What are the three principal differentials of Structured (nodular) interstitial pattern
Metastatic neoplasia, fungal pneumonia, parasitic pneumonia
111
What are the Sheep and goat lung worms named
Dictyocaulus filariae
112
What are the lungworm in cows called
Dictyocaulus viviparus
113
What is the morphology of lungworms
Up to 80mm long and slender white worms
114
Where are ruminant lungworms located
trachea or lumen of bronchioles`
115
What is the epidemiology of ruminant lungworm
Mainly seen in NE USA and Europe. Requires moist, cool environment
Turnout of young cattle into lush pasture
116
What type of lifecycle is D. viviparus
Direct with no intermediate host
117
What is the infective stage of D. viviparus
L3
118
How does D. viviparus get into the lungs
Larvae penetrate the gut
L3 molts to L4 stage and enters lymphatics
L4 migrate to lungs via circulation
L4 larvae molt to L5 in alveoli
119
Where are adults located in D. viviparus located
Aduls are in bronchi, bronchioles or trachea
120
How long is the prepatent period in D. viviparus
21 days
121
How do eggs leave the host in D. viviparus
Females shed eggs, eggs are coughed up and swallowed, hatch and pass in feces as larvae
122
What is the name of the disease of D. viviparus
Verminous bronchitis
Verminous pnuemonia
Husk
123
What are the clinical signs of D. viviparus
Respiratory signs
Cough
Dyspnea
Leathargy
Weight loss
Catarrhal bronchitis
Inhaling eggs to all areas of the lungs uncreases inflammation and severity
124
How to diagnose ruminant lungworm
Baermann exam. L1 in feces
125
What are the two other genera of lungworm in sheep and goats
Protostrongylus rufescens Muellerius capillaris
126
What type of life cycle the sheep and goat genera of lungworm have
Intermediate hosts (snails)
L1 to L3 stages are inside the snail
Ruminants are infected by ingesting the snails
127
Which lung worm species is this
Muellerius capillaris (L1)
128
