Respiratory System

Question 1

What structures are in the
1. Upper
2. Middle
3. Lower
respiratory tract?

Answer 1

1. Nasopharynx, oropharynx, larynx, paranasal sinuses
2. Trachea
3. Left and right primary bronchi, bronchioles, alveoli

Question 2

What type of epithelium is in the

1. Upper resp tract
2. Middle resp tract
3. Lower resp tract
4. Pleura

Answer 2

1. Nose and paranasal sinuses are resp epithelium, pharynx and larynx are squamous epithelium
2. Resp epithelium
3. Everything resp epithelium except alveoli (pneumocytes)
4. Mesothelium

Question 3

Respiratory epithelium

Answer 3

Cubodial epithelium wiht 4 cell types (ciliated cells, mucus producing cells, neuroendocrine cells, reserve/progenitor cells)
Has a protective role - removes particles and bacteria
Under stress, progenitor cells can proliferate and undergo metaplasia into squamous epithelium

Question 4

2 types of pneumocytes

Answer 4

Type I: air exchange cells

Type II: surfactant producing cells (keeps alveoli open)

Question 5

Upper respiratory tract infections

Answer 5

“Common cold”
Caused by viruses (rhinoviruses, influenza, parainfluenza)
Self-limited and do not need antibiotics
Characterized by acute inflammation of nose, paranasal sinuses, larynx, pharynx
Occasionally extends to lungs (viral pneumonia) and can extend to middle ear in children to get otitis media

Question 6

Middle respiratory tract infections and 3 infections in children

Answer 6

Infection of larynx, trachea, and (mainstem bronchi)
Results from extension of URTI and may be associated with pneumonia
3 examples in children:
1. croup (laryngitis) - inflammation of larynx causing stridor and barking cough (parainfluenza virus)
2. Acute epiglottitis
3. Viral tracheobronchitis

Question 7

Lower tract infections (pneumonia)

causes, 2 patterns

Answer 7

Mostly bacterial, but can be viruses and fungi

1. Alveolar (bacterial, focal or diffuse, neutrophils and exudate in alveoli)
2. Interstitial (viral or mycoplasma pneumoniae, diffuse and bilateral, alveolar septal thickening with macrophages and lymphocytes)

Question 8

Dyspnea, tachypnea and hemoptysis defintions

Answer 8

D: shortness of breath
T: rapid breathing
H: bloody cough

Question 9

4 complications of pneumonia

Answer 9

1. Scar tissue
2. Pus in pleural space
3. Large collection of neutrophils with destruction of tissue
4. Chronic changes in lung parenchyma

Question 10

Intrinsic/Non-atopic vs Extrinsic/Atopic asthma stimuli

Answer 10

I: heat/cold, exercise, chemical irritants, psychological stress, infection
E: exposure to allergens

Question 11

Histamine causes 2 things in asthma

Answer 11

Contraction of smooth muscles

Mucus production

Question 12

4 histological changes due to asthma

Answer 12

1. Mucus in lumen
2. Inflammation and basement membrane thickening
3. Enlarged mucus glands
4. Smooth muscle hyperplasia

Question 13

2 main entities of COPD

Answer 13

Chronic bronchitis

Emphysema

Question 14

Chronic bronchitis

Answer 14

Excessive production of bronchial mucus causing productive cough
Must be at least 3 months over 2 years
Over time, permanent dilation of bronchi from persistent inflammation = bronchiectasis
Mucus material stagnates and cannot be cleared by coughing = recurrent pneumonias
Blue bloater (scarring of lungs causes right sided heart failure)

Question 15

Emphysema

Answer 15

Enlargement of air spaces distal to the terminal bronchioles with destruction of alveolar walls
Exact mechanism of smoking induced alveolar injury is unknown
Pink puffer
No productive cough, tachypnea, SOB, barrel chest

Question 16

Pneumoconioses

Answer 16

Lung diseases caused by inhalation of dust, fumes, and inorganic/organic matter

Question 17

3 things lung injury from occupational exposure depends on

Answer 17

1. size/qualities of particle
2. concentration of particles
3. duration of exposure

Question 18

4 main lung lesions associated with asbestos

Answer 18

1. Pulmonary fibrosis - SOB
2. Pleural fibrosis, pleural plaques - asymptomatic
3. Lung cancer
4. Mesothelioma (cancer of the pleura)

Question 19

Carcinoma of the Larynx (4 risk factors, sites, tumor type)

Answer 19

RF: older age, male, smoking, alcohol
S: vocal chords
TT: squamous cell carcinoma

Question 20

Lung carcinoma (risk factor, tumor types, prognosis)

Answer 20

RF: smoking
TT: small cell carcinoma, non-small cell carcinoma, all cell types
P: poor

Question 21

How does smoking cause lung cancer?

Answer 21

Tobacco smoke has polycyclic hydrocarbons

These are carcinogenic and act as irritants

Question 22

Metastatic cancer TO lungs

Answer 22

Even more common than primary lung cancer
May present as solitary lesion, multiple lesions, diffuse involvement of the lungs
Can come from colorectal, kidney melanoma, or breast

Question 23

4 pleural diseases

Answer 23

Pneumothorax (spontaneous or not)
Pleural effusion
Empyema
Mesothelioma

Question 24

Mesothelioma

Answer 24

Rare tumor arising from pleural cells (either layer)
Linked to asbestos exposure, but many are sporadic
Poor prognosis

Question 25

Ghon’s complex

Answer 25

Localized lung lesion from primary infection of M. tuberculosis
Granulomas and enlarged lymph nodes

Question 26

Clinical features of lung cancer (4)

Answer 26

Bronchial irritation = cough (+/- bloody)
Local extension into pleural cavity = pleural effusion = shortness of breath
Distant metastases = presentation depends on site of involvement
Systemic effects of cancer = weight loss, malaise