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Respiratory II Exam 1 > Intro to Resp (Gomez) > Flashcards

Intro to Resp (Gomez) Flashcards

1
Q

Upper Airway Structures

A 
Basic Structures
Sinonasal Tract
Nasal Cavity
Rhinosinuses
Pharynx (“Throat”)
Nasopharynx
Oropharynx
Hypopharynx  
Larynx
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2
Q

Major function of upper airway structures

A 
Conduit air to and from lungs
Heat/Humidify inspired air to 98°/98%
Particle removal from inspired air
Immune surveillance of pathogens
Smell
Speech
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3
Q

Sinonasal Respiratory Mucosa

A

Nasal (Schneiderian) mucosa
lines nasal cavity & rhinonasal sinuses

Three types of epithelial cells
Ciliated pseudostratified columnar cells
Mucin-containing goblet cells
Basal (reserve) cells

Two characteristics of lamina propria
Prominent vascularity
Subepithelial seromucous glands

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4
Q

Acute (infectious) Rhinitis

A 
Symptoms:
Runny and blocked nose
Sneezing
Sore throat and cough
Sinus and ear pain
Headache
Fever
Anorexia
Malaise and lethargy

Common cold = coryza
rhinorrhea = runny nose
transmitted by contact

Can progress –> pharyngitis, tonsillitis, sinusitis, otitis media

Self-limited

Up to 50% of all adult “colds” due to rhinoviruses, (enterovirus)

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5
Q

Allergic Rhinitis - “Hay Fever”

A

Onset: children/young adults & again 30-40s

Classifications:
seasonal
perennial
episodic

Immediate (Type I) hypersensitivity reaction

Immediat rxn (mast cells, edema)
late-phase rxn (late-phase rxn)
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6
Q

Chronic Rhinitis

A

over 1 month of cardinal symptoms (sneezing, rhinorrhea, nasal congestion, postnasal drainage)

most have onset after age 20

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7
Q

Nasal Polyps

A

Recurrent attacks of rhinitis
most patients are not atopic
Usually multiple
May cause obstruction

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8
Q

Sinusitis/Rhinosinusitis

A

Inflammation of sinuses usually associated with inflammation of nasal mucosa

Acute rhinosinusitis- less than 4 days
- Empyema of sinus

Subacute rhinosinusitis 4-12 days

Chronic rhinosinusitis more than 12 weeks

Mucocele of sinus - mucus accumulation from obstruction; no bacterial involvement

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9
Q

Acute (Infectious) Sinusitis (ARS)

A

** Purulent rhinorrhea, nasal congestion and/or facial pain

can be viral (usually clears in 7 days) or bacterial

Moraxella catarrhalis (mainly children)
suggested by
Presence of symptoms for seven or more days
Symptoms initially improve and then worsen
Sinusitis associated with dental disease

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10
Q

Predisposing genetic/ medical Factors for Development Chronic Sinusitis

A

ASA triad; aspirin induced chronic rhinosinusitis, nasal polyps, and severe bronchial asthma

immotile cilia syndrome– Kartagener (defective ciliary action and situs inversus)

cystic fibrosis

chronic sinusitis- most is obstructive

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11
Q

ostiomeatal complex (OMC) -

A

channel that links thefrontal, anterior and middle ethmoid, and the maxillary sinuses to the middle meatus
OMC patency is critical for normal sinus ventilation and drainage

  1. Frontal sinus–>infundibulum of middle meatus
  2. Anterior ethmoid sinus–>middle meatus
  3. Middle ethmoid sinus–>ethmoid bulla of middle meatus
  4. Maxillary sinus–>middle meatus
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12
Q

chronic obstructive sinusitis symptoms and obstructions

major etiology

A 
Common Symptoms
Facial pain, pressure, fullness 
Nasal obstruction/congestion 
Nasal drainage/postnasal drip 
Decreased sense of smell

Obstruction may be
non-infected (“mucocele”)
suppurative (“empyema”)

Mostly staph aureus

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13
Q

Fungal Sinusitis types

A

Allergic Fungal
Sinusitis– will see lots of fungus

Fungus ball (Mycetoma)

Invasive Fungal Sinusitis

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14
Q

Allergic vs Allergic Fungal Sinusitis

A

fungal will have hyphae

allergic will have mucus (no fungi)- Charcot Leyen Crystals

allergic fungal will have both

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15
Q

Causes of nectrotizing lesions of upper airways

A

Vascular
Granulomatosis with polyangiitis/Wegener

Infectious
Rhinocerebral mucormycosis/Rhinocerebral zygomycosis

Hansen disease/lepromatous leprosy

Malignancies: extranodal NK/T cell lymphoma

miscellaneous (sarcoidosis, etc.)

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16
Q

Mucormycosis

A

Caused by saprophytic mold fungi (Mucoromycotina)
In infected tissues produce irregular shaped hyphae that have few or no septa
Usually uncontrolled diabetes where ketoacidosis is present

17
Q

Lung intimate neighbors

A

aorta and esophagus, vena cava, heart

18
Q

Conducting Vs. Respiratory

A

Conducting:

  1. Trachea2. Carina & stem bronchi3. Interpulmonary bronchi4. Segmental bronchus5. Bronchiole
    5a. Terminal bronchiole (2 mm)

Respiratory:
5b. Respiratory bronchiole6. Alveolar duct7. Alveolus (7 mm)

19
Q

Inhaled Particle Issues

A

0.5-5 micron most dangerous

> 5 µ cleared by mucociliary action
3-5 µ reach bronchioles
less than 2 µ reach the alveoli

Lancet (needle) shaped objects can go further than ovoid objects of same maximum size

20
Q

Microscopic Anatomy

A

Trachea & bronchi

  • Ciliated & goblet cells
  • Mucus
  • Smooth muscle
  • Seromucous glands
  • Cartilage

Bronchioles

  • Ciliated & Clara cell
  • Surfactant
  • Smooth muscle
Alveoli
Type I pneumocyte 
Type II pneumocyte
          Lamellar bodies
Alveolar septa
21
Q

difference between type II and type I pneumocytes

A

type 1 cannot replicate; type 2 have to do that

22
Q

Alveoli

A 
Air sac (small pockets) invaginations (200 um)
O2 & CO2  exchange (blood-air barrier)
Cellular Components
Surface alveolar lining cells 
95% Type I (non-div.)
5% Type II (div.)
Capillary endothelial cells
Fused basal laminae of alveolar and endothelial cells
Occasional Interstitial cells 
Alveolar macrophages
Pores of Kohn (inter-alveoli openings) 
Anastomosing pulmonary capillaries
23
Q

Atelectasis

A

Incomplete expansion (Neonatal)

Acquired collapse (Adult):

Resorption (obstruction)

  • Airway obstruction; mucus, foreign body, tumor
  • **Mediastinal shift toward involved lung

Compression

  • External pressure including elevated diaphragm
  • Mediastinal shift away from involved lung

Contraction
- Secondary to fibrosis of lung or pleura
Irreversible

All atelectasis at risk for infection

24
Q

linear (plate-like) atelectasis

A

esp. seen after surgery due to pt not breathing as deep… leads to collapsed peripheral lung areas (absorption atelectasis)

25
Q

Two Main Types of Pulmonary edema

A

Hemodynamic
Most Common
“heart failure” cells
chronic –> alveolar fibrosis: brown induration of lung

Microvascular (alveolar) injury (infection, toxins, etc., can –> Acute Respiratory Distress Syndrome

26
Q

Non-cardiogenic Pulmonary Edema criteria

A

1-Acute onset of dyspnea
2-Hypoxemia
3-Bilateral infiltrates
4- Absence of Primary left-sided heart failure

Can –> ARDS/ DAD (diffuse alveolar damage)

AIP (acute interstitial pneumonia)

27
Q

Adult Acute Respiratory Distress Syndrome

A

(Diffuse Alveolar Damage)

Occurs in patients with severe disease

Diffuse damage to alveolar capillary walls –> neutrophilic migration

Have secondary loss of surfactant

28
Q

Conditions Associated with Development of Acute Respiratory Distress Syndrome

A

Sepsis, diffuse pulmonary infection, gastric aspiration

mechanical trauma, including head injures

near drowning

fractures with fat embolism
burns, ionizing radiation

smoke, gases, chemicals

Paraquat - inhaled

drug overdoses

Reperfusion injury after lung transplant

29
Q

ARDS (Diffuse Alveolar Damage) Clinical

A

Patients are already ill when ARDS is superimposed

Diffuse bilateral infiltrates on xray

High mortality

30
Q

Acute Interstitial Pneumonia

A

(AIP, Hamman-Rich Syndrome)

Symptoms similar to ARDS 
But, no associated causative disorder
Ave. age – 59 years, M=F
Acute respiratory failure following 
illness

Respiratory II Exam 1 (12 decks)

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