Module 8 Respiratory

Question 1

Ventilation

Answer 1

• Air movement from upper to lower resp

Question 2

Ventilation Steps

Answer 2

1. Deep breath
2. Engage diaphragm & intercostal muscles
3. Air into trachea
4. Bronchi main, primary, secondary)
5. Bronchioles (terminal, respiratory)
6. Alveolar ducts
7. Alveolar sac

Question 2

Perfusion

Answer 2

• Movement of CO2 blood
• From the right side of heart
• Into lung to gas exchange site
• O2 blood back to left side of heart

Question 3

Gas Exchange

Answer 3

• Ventilation & perfusion meeting point
  Occurs at alveolar-capillary membrane

Question 4

Alveolar-Capillary Membrane Composition

Answer 4

• Pneumocytes (epithelial cell of lung)
• Endothelial cells
• Interstitial tissue

Question 5

Respiratory Failure

Answer 5

• Failure of ventilation/perfusion
• Mismatch of ventilation/perfusion

Question 6

Influencing Factors of Pneumonia

Answer 6

• Dose & virulence of organism
• Host susceptibility
• Impaired local defense mechanisms
• Muco-ciliary apparatus injury
• Alveolar macrophage interference
• Fluid/secretion accumulation in alveoli
• Immunocompromised

Question 7

Pneumonia

Answer 7

• Inflammation of lung
• Via secondary infection

Question 8

Pneumonia Diagnosis

Answer 8

• Chest x-ray
• Bloodwork (increased WBC count)
• Blood & sputum culture

Question 9

Pneumonia Presentation

Answer 9

• Cough
• Fever
• Chills
• Malaise
• Pain on inspiration

Question 10

Pneumonia Classification

Answer 10

• Morphological (lobar vs broncho)
• Clinical setting (hospital, immunocompromised)

Question 11

Community Acquired Pneumonia (CAP)

Answer 11

• Bacterial (streptococcus, haemophilus)
• Atypical syndrome (influenza, chlamydia)

Question 12

Aspiration Pneumonia

Answer 12

• Altered level of consciousness
• Impaired laryngeal/esophageal/gastric function
• Periodontal disease
• Stomach acid, particulate matter, anerobic bacteria aspirated

Question 12

Hospital Acquired (Nosocomial Pneumonia)

Answer 12

• Severe underlying disease
• Immunosuppressed
• Prolonged antibiotic therapy
• Invasive access devices
• Ventilated

Question 13

Immunocompromised Host Pneumonia

Answer 13

• Defense mechanisms suppressed
• Immunosuppressive therapy
• Opportunistic infectious agent

Question 14

Pneumonia Complications

Answer 14

• Abscess
• Empyema
• Septicemia (blood infection)

Question 14

Tuberculosis (TB)

Answer 14

• High morbidity & mortality
• Primarily within developing countries
• Mycobacterium causative organism
• Acid-fast bacillus

Question 15

Populations Affected by TB

Answer 15

• Poverty
• Crowded living conditions
• Chronic debilitating diseases
• Immunocompromised

Question 15

TB Infectious Patients

Answer 15

• Bacilli on lower resp tract sampling
• Increased multi-drug resistance

Question 16

TB Transmission

Answer 16

• Dependent on viable bacilli
• Aerosolization of small droplets
• Host susceptibility

Question 16

TB Skin Test

Answer 16

• Detect cellular immunity to intracutaneous agent
• Intradermal injection of protein derivative of tuberculin

Question 17

Positive TB Test Results

Answer 17

• 10mm+
• Induration 48, 72, 96 hrs
• Prior or current infection
• Prior immunization

Question 18

Chronic Bronchitis

Answer 18

• Productive cough most of week
• 3 months of year
• 2+ successive years

Question 19

Chronic Bronchitis Etiology

Answer 19

• Smoking
• Airway irritation
• Protective changes
• Hypersecretion of mucus
• Hyperplasia of submucosal glands
• Squamous metaplasia
• Airway obstruction
• Decreased ventilation

Question 20

Emphysema

Answer 20

- Damage of acinus (distal lung) - Destruction of alveolar wall - Enlargement of airspaces - Occurs with COPD

Question 20

Emphysema Etiology

Answer 20

- Smoking - Protases & elastases released - Damage of elastic tissue - Dilated distal acini - Impaired elastic recoil - Airflow obstruction - Decreased ventilation

Question 21

COPD Clinical Features

Answer 21

- Shortness of breath - Chronic productive cough - Wheezing - Chest tightness - Frequent cold/flu - Low energy - Weight loss - Cyanotic

Question 22

COPD Spirometry

Answer 22

- Decreased forced expiratory volume (FEV) - Decreased FEV to forced vital capacity (FVC) ratio

Question 23

COPD Complications

Answer 23

- Recurrent respiratory infections - Acute respiratory failure - Barotrauma/pneumothorax - Pulmonary hypertension - Heart disease - Lung cancer - Malnutrition/cachexia

Question 24

Lung Cancer Risk Factors

Answer 24

- Smoking (duration & amount) - Industrial hazards - Air pollution - Radiation - Genetic - Old pulmonary scars

Question 25

Non-Small Cell Lung Cancer

Answer 25

- Squamous cell carcinoma - Adenocarcinoma

Question 25

Small Cell Lung Cancer

Answer 25

- Centrally located - Hilar/mediastinal tumours - Rapid growth - Metastases to extrapulmonary sites - Paraneoplastic syndrome

Question 26

Squamous Cell Carcinoma

Answer 26

- Centrally located - Grow within lumen - Airway obstruction - May cavitate (necrosis) - Common in male smokers

Question 27

Adenocarcinoma

Answer 27

- Peripherally located - Common in female non-smokers - Targeted molecular therapies available

Question 27

Lung Cancer Presentation

Answer 27

- Local symptoms - Spread to adjacent thoracic structures - Distant metastasis

Question 27

Lung Cancer Diagnosis

Answer 27

- Chest x-ray & CT - Sputum cytology - Bronchoscopy - Endoscopic ultrasound guided therapy - Transthoracic - Pleural fluid cytology

Question 27

Non-Small Cell Treatment

Answer 27

- Surgery (early stage) - Chemo/radiation (advanced stage) - Targeted molecular therapy (advanced stage) - Immune therapy (advanced stage)

Question 28

Small Cell Treatment

Answer 28

- Chemotherapy - Radiation

Question 29

Prognosis Determination

Answer 29

- Stage (higher = poorer) - Subtype

Question 30

Lung Cancer Subtypes

Answer 30

- Small cell carcinoma (poorer) - Location - Performance status of patient - Age & sex - Genetic changes