Respiratory Pathologies

Question 1

What is acute bronchitis?

1 mark

Answer 1

Inflammation of the bronchial tree anywhere between the trachea and the bronchioles.

Question 2

If the inflammation of acute bronchitis extends into the arterioles & alveoli what is the condition known as?

1 mark

Answer 2

Bronchopneumonia

Question 3

What signs and symptoms would make you consider a diagnosis of bronchitis?

3 marks

Answer 3

Persistent, productive cough along with sore throat, nasal congestion, fatigue & fever. Most symptoms subside after 10 days, cough may persist for several weeks.

Question 4

Describe the etiology of bronchitis

5 marks

Answer 4

When the bronchi are irritated or infected by a pathogen an inflammatory response occurs.
The tubes swell, cilia are damaged and XS mucus is produced - causes coughing & wheezing as air moves in & out of obstructed airways.
Most cases are complications of cold & flu where the virus moves down to the chest. Other causes are bacteria, fungi & irritants like fumes, pollutants & contaminants.
Chronic reflux may also irritate bronchi.

Question 5

What is Bronchiectasis?

2 marks

Answer 5

A disorder caused by repeated lung infections that cause the tubes to permanently widen & be unable to move mucus out of the body. Mucus pools in the lungs making them prone to further infections.

Question 6

What is a common cold?

2 marks

Answer 6

An infection of the respiratory tract caused by one of hundreds of viruses.
After infection the body develops immunity to that particular virus but is still susceptible to the many different viruses - so no vaccine.

Question 7

Give 4 examples of secondary infections that might follow on from a common cold

2 marks

Answer 7

Sinusitis
Laryngitis
Acute bronchitis
Pneumonia
Exacerbation of asthma

Question 8

What is influenza ‘flu’ & what symptoms might you expect in a patient with flu?

3 marks

Answer 8

A viral infection of the respiratory tract.
High fever, muscle & joint aches that may last up to a week followed by runny nose, sneezing, coughing & general malaise.

Question 9

Explain what happens in Pneumonia

4 marks

Answer 9

Pneumonia is an infection of the lungs, brought about by bacteria, viruses or fungi.
Alveoli fill with dead WBCs, mucus & fluid seeping back from capillaries.
Diffusion of gases becomes impossible.
Abcesses may form & capillaries may be damaged causing bleeding into the alveoli & eventually blood in the sputum.

Question 10

What signs & symptoms would you expect to find in a patient suffering from pneumonia?

4 marks

Answer 10

Can vary depending on the cause & how much lung is affected.
May include:
Coughing, high fever, chills, sweating, delirium, MAPs, chest pains, thick & coloured sputum, Shortness of Breath, cyanosis, pleurisy.
May look like flu initially but instead of getting better gets rapidly worse with fever up to 104F.

Question 11

What happens in Sinusitis?

5 marks

Answer 11

Sinusitis is a condition where the mucus membranes that line the sinuses become inflamed and swollen.
The sinuses contain mucus membranes & cilia to move mucus along so trapped pathogens can be moved along or swallowed & destroyed by stomach acid.
When cilia break down or are paralysed eg by smoke or viruses, mucus accumulates & causes inflammatory response in the underlying epithelial cells. The sinuses fill with sticky pus-filled mucus that can’t drain & forms an ideal growth medium for bacteria.
Alternatively mucus membranes are stimulated by allergens eg pollen, resulting in inflammation - hayfever (allergic rhinitis).

Question 12

What signs & symptoms would you associate with sinusitis?

3 marks

Answer 12

Severe headaches, esp. on waking. Aggravated by bending forward because of increased pressure on mucus membranes. Affected areas may be painful to touch, swelling or puffiness around the eyes or cheeks.
May be fever & chills, sore throat & coughing, congestion or runny nose, fatigue & malaise.
Sinus mucus - streaked or opaque, pale green to yellow brown.
Hay fever mucus - thin, runny & clear.

Question 13

Briefly describe how Chronic Bronchitis develops

8 marks

Answer 13

Chronic bronchitis is the result of long term irritation to the bronchial tubes by cigarettes, chemicals etc which cause an inflammatory response.
This destroys the elastin fibres which help deflate the lungs, so it takes more effort to exhale.
It increases the growth of mucus producing cells and XS mucus = less O2 enters the body with each breath.
Also increases resistance to the movement of air in & out of the lungs.
The heart then needs to work harder to push more blood to the lungs & the RBC production may increase to carry more O2 - making it thicker & harder to push to the lungs.
The right side of the heart that pushes blood to the lungs gets weaker resulting in swelling in the legs & ankles as there is a build up of blood trying to get into the right side of the heart.
As O2 levels drop in the blood it becomes more acid as there is more dissolved CO2 turning to carbonic acid.

Question 14

What complications might you expect to be associated with chronic bronchitis?

2 marks

Answer 14

Inflamed bronchi that are producing lots of mucus are vulnerable to viral & bacterial infection. Pneumonia may result from cold or flu viruses more easily & there is significant risk from right sided heart failure.

Question 15

What is emphysema?

2 marks

Answer 15

A condition in which the alveoli of the lungs become stretched out & inelastic. They merge with each other, decreasing the surface area, destroying capillaries & reducing CO2-O2 exchange.

Question 16

Explain how emphysema develops

5 marks

Answer 16

When we exhale elastin fibres in the lung tissue deflates the lungs - it’s a passive process unless we choose to force more air out.
Long term exposure to cigarette smoke or other pollutants destroy a protein that protects the elastin, so the elastin is destroyed.
The alveoli lose the ability to recoil and so fill up with mucus which interferes with CO2 & O2 exchange. Instead of emptying & filling with every breath they only partially empty or stay completely full.
The alveolar walls eventually break down and merge with each other, forming larger sacs called bullae which have less surface area for gaseous exchange & less volume. SO the patient has to work much harder to move air in & out of the lungs.

Question 17

What is Asthma?

2 marks

Answer 17

A chronic disorder of the airways that interferes with breathing.
It may be triggered by external factors such as allergens but also linked to internal factors eg emotional stress.

Question 18

What is the disease process in asthma?

4 marks

Answer 18

All bronchioles are sensitive to foreign debris but asthmatics bronchioles are extremely irritable & hyperreactive. Their bronchiole tubes are always in a state of ongoing inflammation - always poised to begin an attack.
When they encounter a trigger the irritated membranes lining the tubes swell & secrete extra mucus. Some small passageways may be completely blocked by mucus so it’s v difficult to breathe.

Question 19

What are the major signs & symptoms associated with asthma?

5 marks

Answer 19

Shortness of breath, wheezing, coughing.
Inhaling not difficult but exhaling extremely limited as bronchioles are constricted so alveoli don’t empty easily.
If symptoms extreme & prolonged patient may become panicky, causing sweating, increased heart rate & anxiety.
In emergencies the lips & face become bluish - cyanosis.
Attacks are sporadic lasting from a few minutes to a few days. Between the attacks the lungs are normal, until eventually smooth muscle cells get bigger & epithelial cells become fibrotic, leading to continuous symptoms.