Respiratory Health Flashcards
What are the basic functions of the Respiratory Tract?
- oxygenation of the blood
- removal of waste products (carbon dioxide)
What do the basic functions of the Respiratory Tract require?
- ventilation (movement of air)
- perfusion (movement of blood)
- gas exchange
What are the different parts of the Respiratory Tract?
- trachea
- bronchi (main, primary, secondary)
- bronchioles (terminal, respiratory)
What are the Lung Acinus?
the most distal part of the lung, or Lung Aveolus
What are Pneumocytes?
epithelial cells of the lungs
What do the endothelial cells do in the lungs?
line capillary cells
What is the Alveolar Capillary Membrane?
Site of gas exchange
What is Pneumonia?
Inflammation of the lung secondary to infection
How do infectious organisms enter the lung?
- inhalation
- aspiration
- blood
- direct inoculation: surgery
What are factors that determine if infection will occur?
- dose & virulence of the organism
- impaired local defence mechanism
- impaired systemic defence mechanism
What are our local defences?
Defences there to target an infectious particle that we don’t want in the lung
What are our systemic defences?
defences that pretain to our immune system
What occurs when the local defence mechanisms are impaired within our lungs?
- loss of cough reflex
- injury to the mucociliary apparatus
- interference to alveolar macrophages
- accumulation of fluid or secretions within alveoli
What is our cough reflex?
designed to help clear infections particles and other unwanted substances that aren’t suppose to be going into the lung
What is our Mucociliary Apparatus?
designed to impede the access of infectious particles and other infectious substances into the lungs
What does the accumulation of fluid do?
Allows for the development of infectious particles
What occurs when the Systemic Defence Mechanisms are impaired?
Immunocompromised host
How do you diagnose Pneumonia?
- Clinical Presentation
- Chest X-ray
- Bloodwork
- Microbiology Studies: blood and sputum culture
What is the clinical presentation of Pneumonia? (5)
- cough
- fever
- chills
- malaise
- pain on inspiration
What are the two morphological presentations of Pneumonia?
- lobar
- broncho
What are the different types of Pneumonia?
- Community acquired
- hospital acquired
- aspiration
- immunocompromised host
What are the different types of Bacterial Community Acquired Pneumonia?
- streptococcus pneumoniea: most common
- haemophilus influenzae
What is an atypical pneumonia syndrome?
Mycoplasma
What is Hospital Acquired Pneumonia?
- nosocomial pneumonia
- life threatening
- E. Coli
- Pseudomonas aeruginosa
- Staphylococcus aureus
What are the signs and symptoms of Aspiration Pneumonia?
- altered level of consciousness
- impaired laryngeal-pharyngeal/esophageal/gastric function
- Periodontal disease
What is aspirated in Aspiration Pneumona?
- stomach acid
- particulate matter
- anaerobic (oral flora) bacteria
What occurs when an Immunocompromised Host obtains Pneumonia?
- immune defences are suppressed by disease
- immunosuppressive therapy for organ transplantation
- Chemotherapy
- Irradiation
What are the Opportunistic Infectious agents for Pneumonia in Immunocompromised Host?
- rarely cause infection in normal hosts
- bacteria
- Viruses
- Fungi
What are the Complications of Pneumonia?
- Abscess
- Empyema
- Septicemia
What is Abscess?
Tissue destruction of the lung by infectious fluid cumulation
What is Empyema?
When the pleural fluid that surrounds the lung becomes infected, and there is an accumulation of pus in the cavity
What is Septicemia?
Pneumonia that spreads to the blood
What effect does Antibiotics have on Abscess, Empyema, Septicemia?
It has no effect, they need to be drained
What is Tuberculosis? (4)
- major cause of morbidity and mortality world wide
- causative organism is Mycobacterium Tuberculosis
- mostly occurs in developing countries
- flourishes in settings of poverty, crowded living conditions, and in people with chronic debilitating diseases and/or immunocompromise
What are the types of Tuberculosis?
- pulmonary
- extrapulmonary
When is Tuberculosis infectious?
When the TB bacilli can be demonstrated in the lower respiratory tract sampling (ex. sputum)
What does person-to-person transmission depend on?
- # viable bacilli
- aerosolization of small droplet nuclei
- host susceptibility
What is a TB skin test?
- test that detects the presence of cellular immunity to an intracutaneous antigen
- intradermal injection of a purified protein derivative of tuberculin
- positive test of 10 mm or more induration at 48, 72, or 96 hours
What does a positive TB skin test mean?
- prior or current infection
- prior immunization
What are the main types of Chronic Obstructive Pulmonary Disease (COPD)?
- Chronic Bronchitis
- Emphysema
What is Chronic Bronchitis?
when a patient has a productive cough on most days of the week for three months of the year for two or more successive years
What is the Etiology of Chronic Bronchitis?
cigarette smoking (most cases)
What is the process of Chronic Bronchitis?
1) smoking
2) Irritation of airways
3) Protective changes
4) Airway obstruction
5) decreased ventilation
What is Emphysema?
- damage of the acinus
- destruction of the alveolar wall
- abnormal & permanent enlargement of the airspaces
- often occurs with Chronic Bronchitis
What is the Etiology of Emphysema?
cigarette smoking (many but not all cases)
What is the process of Emphysema?
1) smoking
2) proteases & elastases released
3) Damage of elastic tissue
4) dilated distal acini with impaired elastic recoil
5) airflow obstruction
6) decreased ventilation
What are the clinical features of COPD? (6)
- dyspnea
- chronic productive cough
- wheezing, chest tightness
- frequent colds/flu
- low energy, weight loss
- cyanotic (blue)
What is a nickname for Chronic Bronchitis?
Blue bloater
What is a nickname for Emphysema?
Pink Puffer
How do we diagnose COPD?
- Spirometry
- Chest x-ray
What are the consequences of COPD? (7)
- recurrent respiratory infections
- acute respiratory failure
- barotrauma/pneumothorax
- pulmonary hypertension
- heart disease
- lung cancer
- malnutrition/cachexia
What are the Risk Factors for Lung Cancer? (6)
- smoking
- Industrial hazards
- air pollution
- radiation therapy
- genetic factors
- region of old pulmonary scars
What are the two types of Primary Malignant Lung Neoplasms?
- non-small cell lung cancer
- small cell lung cancer
What is Small Cell Lung Cancer? (5)
- usually centrally-located hilar or mediastinal tumours with rapid growth
- almost always occur in pts who smoke
- most have already metastasized by the time they are diagnosed
- paraneoplastic syndromes not common
- aggresive
What is the treatment for Small Cell Lung Cancer?
Chemotherapy
What is the Prognosis for Small Cell Lung Cancer?
Exceptionally poor
What are the two types of Non-small Cell Lung Cancer?
- Squamous cell carcinoma
- Adenocarcinoma
What is Non-small Cell Squamous Cell Carcinoma?
- usually centrally-located tumours; tend to grown within the lumen
- may cavitate due to central necrosis
- most common cancer in male pts who smoke
What is Non-small Cell Adenocarcinoma?
- usually peripherally located
- most common lung cancer to occur in female pts and non-smoking pts
- targeted molecular therapies may be used
What is the clinical presentation of Lung Cancer? (5)
- 5% asymptomatic
- local symptoms: cough, dyspnea, chest pain, hemoptysis
- Spread to adjacent thoracic structures
- Distant Metastasis
- Non-specific symptoms: anorexia, fatigue, weight loss
What are Paraneoplastic Syndromes?
When our immune system recognizes that there is a cancer in our body, and it targets not only the tumour but parts of our body
What are Paraneoplastic Syndromes associated to Small Cell Carcinomas?
- Syndrome of inappropraite ADH secretion (SIADH)
- Cushing syndrome
- Lambert-eaton myasthenic syndrome
What are Paraneoplastic Syndromes associated to Squamous Cell Carcinoma?
Hypercalcemia (Parathyroid hormone or prostaglandin E)
What are Paraneoplastic Syndromes associated to both Small Cell and Squamous Cell Carcinomas? (3)
- Peripheral neuropathy
- Myasthenia gravis
- Digital Clubbing
How is Lung Cancer Diagnosed? (7)
- history and physical examination
- Chest X-ray & CT
- Sputum cytology
- Bronchoscopy
- Endoscopic ultrasound-guided transbronchial or transeophageal biopsy of the lymph nodes
- transthoracic biopsy
- Pleural fluid cytology
What is Sputum diagnoses best used for?
diagnosing a Central Tumour
What is the treatment for Non-small cell Lung CA? (4)
- surgery (early)
- Chemotherapy & radiation (advanced)
- Targeted molecular therapy (advanced)
- Immune therapy (advanced)
What is the treatment for Small Cell CA?
Chemotherapy & radiation
What does the Prognosis of Lung Cancer depend on?
- stage
- subtype
- location
- performance status of the pt
- age and sex of pt
- genetic changes that predict response to targets therapies
