Respiratory Pathology

Question 1

Why are respiratory tract infections so common in children?

Answer 1

Poor sanitary habits, low defences

Question 2

How would you explain the management of antibiotics for URTI?

Answer 2

Antibiotics only work for bacterial infection not viral, so eating it without reason creates resistance of the pathogen to the medicine.

Question 3

what are the common pathogens for influenza

Answer 3

Type A, B and C

Question 4

Compare the clinical features for common cold an influenza

Answer 4

- Cold
Onset Gradual
Fever rare
headache rare
malaise mild
a runny nose yes 
cough productive
chill rare

- Influenza
Onset Abrupt
Fever common
headcahe severe
malaise yes
runny nose sometimes
cough dry
chill common

Question 5

How does seasonal influenza infect the respiratory tract

Answer 5

Virus binds and enters respiratory epithilium
makes the host cells replicate the virus
leads to necrosis of respiratory tract

Question 6

why is influenza a problem over other URTI?

Answer 6

It may spread to lower respiratory tract and create necrosis in the lungs. may lead to death

Question 7

What is croup, clinical presentation, mechanism and management and progression?

Answer 7

Acute laryngotracheobronchitis,

Clinical - cold, fever, hoarseness, cyanosis, night barking

Pathogens - influenza, parainfluenza, respiratory sycytial virus

Mechanism - invade and destroy epithelial cell, acute inflammation trachea, reduce lumen airway, hypoxia

Question 8

what is pneumonia and what are the different pathogens that cause it?

Answer 8

Inflammation of lung tissue.
Typical
- Streptococcus
- staphylococcus aureus

Atypical

• legionella
• viral pneumonia
• mycoplasm pneumonia

Question 9

What are the clinical features of pneumonia

Answer 9

Fever
pain 
dry cough
headache 
myalgia
tachypnea 
Tachycardia 
Haemoptysis

Question 10

What is tuberculosis and what mechanism is

responsible?

Answer 10

White lung lesion

pathogen: Mycobacterium tuberculosis

transmission by inhalation

Question 11

What are the possible outcomes for tuberculosis?

Answer 11

lung tissue necrosis and caceus necrosis

Question 12

What is the difference between Mantoux and Calmette Guerin?

Answer 12

Mantoux: Skin test to observe exposure to tuberculosis

1) has had vaccine
2) Previous exposure to pathogen
3) life virus
4) Negative - indicative for vaccination

Calmette Guerin: Vaccin to stimulate immunity to virus

Question 13

What are the mechanisms responsible for infective rhinitis (common cold)?

Answer 13

• Rhinovirus
• Adenovirus
• Echovirus

Question 14

What is the mode of transmission for infective rhinitis?

Answer 14

Secretion in hand
coughing
sneezing

Question 15

What is the mode of transmission for influenza?

Answer 15

Airbourne

• Talking
• coughing
• sneezing

Question 16

What is the pathology of infective rhinitis?

Answer 16

UTI
Virus enters epithelium 
inflammation of vassal mucosa 
Rhinorhea and congestion 
spread to sinus, nasopharynx, tonsils and ears

Question 17

What is whooping cough?

Answer 17

Bacterial infection with Bordetella pertussis

pathophys: Invade and paralyze macrophage

Question 18

What are the 3 stages of whooping cough?

Answer 18

Catarrhal - inflammation, lacrimation, cough
paroxysmal - change in cough
convalescent - cessation of symptoms 4-6 weeks later

Question 19

What is allergic asthma and its pathophysiology?

Answer 19

Chronic inflammatory disorder of the airways (airflow obstruction)

Exposure to allergen causes inflammatory response

1) inc. vascular permeability
2) Inc. mucus hypersecretion
3) Bronchoconstriction

Question 20

What are the different types of asthma?

Answer 20

Allergic asthma: Children - Dust mite, pollen, fur, wheat, fish, egg

Infectious asthma: CHildren - Respiratory syncytial virus, Influenza rhinovirus

Exercise-induced: High intensity exercise

Occupational asthma: exposure to allergic mediators, agriculture, pesticide, animal handlers

Drug-induced asthma: Aspirin NSAID beta blockers.

Question 21

What is chronic bronchitis and its pathophysiology?

Answer 21

chronic productive cough

Mucus hypersecretion
persistent inflammation of bronchioles
replacement of cilial cells with squamous cells

Question 22

What is emphysema pathophysiology?

Answer 22

Permanent distention of airspace distal to terminal bronchus

Pathophysiology

• destruction of elastin in alveolar wall
• destruction of elastase
• prevent lung from neutralizing effect of elastase

Question 23

What are the causes of emphysema?

Answer 23

Smoking - bronchioles

Congenital abnormality - Alveolar ducts

Question 24

Clinical presentation of asthma

Answer 24

wheezing 
dyspnea
chest pain
cough
tachypnea 
anxiety

Question 25

What is the clinical presentation of status asthmatics?

Answer 25

``` Compensatory posture inc. accessory mm. respiration tachycardia sweating inability to speak ``` no response to meds respiratory arrest spontaneous pneumothorax air trapping

Question 26

Asthma complications?

Answer 26

pneumothorax status asthmatics rupture of pleb

Question 27

What are the4 types of medications for asthma?

Answer 27

preventers relievers controllers antibody therapy

Question 28

What are the causes of chronic bronchitis?

Answer 28

smoking | pollution

Question 29

what are the cinical features of chronic bronchitis?

Answer 29

Initial - Blue puffer - daily productive cough for < 3/12 for 2yr - Cyanotic - Overweight - pheripheral oedema - wheezing - ronchi Long-term - pulmonary hypertension - Rt heart failure - Acute respiratory failure - death

Question 30

what are the cinical features of emphysima?

Answer 30

Pink - permanent enlargement and destruction of airspace - old - thin - quiet chest - sever dyspnea

Question 31

What is pneumothorax?

Answer 31

presence of air in pleural cavity

Question 32

what is the aetiology and pathophysiology of pneumothorax?

Answer 32

Primary spontaneous = young, thin, male, Inc pleural pressure. Secondary spontaneous = asthma, emphysema, cyst fibrosis traumatic open = stab wound or traumatic close = rib fracture

Question 33

What is the clinical presentation of pneumothorax?

Answer 33

``` HBP Tachypnea (no O2) Decreased chest movement no breath sound cyanosis tactile fremitus ```

Question 34

What are the different types of benign tumours in lungs?

Answer 34

Pulmonary Hamartoma: disorganized cartilage, adipose tissue, smooth mm. entrapped epithelium, asymptomatic Pulmonary chondroma: cartilage tumour that appears in multiple sites.

Question 35

What evidence links smoking to bronchogenic carcinoma?

Answer 35

Lung cancer is doses related, the more you smoke the more you are likely to get a tumour. there are clear carcinogenic mechanism: benzopyrene in smoke is gene 53 tumour protein smoking leads to cellular change: metaplasia, carcinoma in situ, invasive cancer.

Question 36

Differentiate between “Non-small cell lung carcinomas” and “small cell lung carcinoma"

Answer 36

Non small cell carcinoma 85% of carcinoma derived from epithilium small cell carcinoma = 15% lung cancer known as oat cell they secrete substances

Question 37

What are the clinical features for bronchogenic carcinoma?

Answer 37

Compresion - Hornes syndrome - Swelling face - upper limb neuro Obstruction - appearance or change in cough - Dyspnea - pericardial effusion Invasion of blood cells - productive cough - blood in cough

Question 38

What are the mains points of spread and common sites of bronchogenic carcinomas?

Answer 38

Spread = blood, lymph, direct extension | Lung, liver, breast, kidney, bowel, cervix, skin

Question 39

What is haemothorax?

Answer 39

blood in cartilage clinical pleural cavity

Question 40

What is a tension pneumothorax?

Answer 40

when chest wound acts as a one-way valve and air gets trapped in pleural increasing pressure, displacement of the mediastinum and compressing lung. - leads to asphyxiation