Exam 3 Flashcards
What is considered the upper respiratory tract?
Throat up
What is considered the lower respiratory tract?
Throat down
What causes the viral common cold?
Rhinoviruses
Parainfluenze
RSV
Adenoviruses
What are the symptoms of the viral common cold?
The viral common cold is self limiting
Increased secretions
Sore Throat
HA
Fatigue
Post-nasal drip
(Symptoms are normally from the throat up)
How long does the viral common cold last?
Normally runs its course in 7 days with an incubation period of 2 days
How are viruses spread?
By Contact (fingers)
Portal of Entry (nasal mucosa and conjunctival surfaces)
What is the progression of Rhinosinusitis?
Viral URI/allergic rhinitis leads to mucousal swelling which leads to ostia obstruction and impaired mucociliary clearance
What are other non-viral causes of rhinosinustitis?
Bacterial
Swimming
Driving
Abuse of nasal decongestants
How is rhinosinusitis classified?
Classified as acute or chronic
Acute is equal or under 4 weeks
Chronic is over 12 weeks
What are the clinical manifestations of rhinosinusitis?
Purulent nasal drainage
Decreased sense of smell and fever
A fever can distinguish what about rhinosinusitis?
Whether the cause is bacterial or viral
Influenza is caused by?
The influenze virus NOT a bacteria
Where in the respiratory tract does the flu affect?
Both upper and lower
Where does influenza target and what is it’s method of action?
Influenza targets and kills mucous-secreting ciliated epithelial cells, creating holes in the basal membrane cells.
Extracellular fluid escapes which causes a runny nose
What are the 3 types of RNA single strand viruses?
A, B, C
Type A viruses are further divided by H(1-18) and N(1-11) subtypes (Surface glycoproteins)
Pandemic Influenzas
How is influenzas spread?
inhalation of droplets
What is H(1-18)?
hemoglutenin antigen on surface of viruses
What is N(1-11)?
Enzymes that predicts how well a virus can replicate
What are the systemic manifestations of the flu?
Body aches, fatigue, headache, fever, chills
What is the onset and duration typically of influenza?
Acute onset, malaise over a morning.
Symptoms peak by day 3-5, and disapears by 7-10 with an incubation period of 1-2 days
What are the possible complications of influenza?
Pneumonias
Exacerbation of pre-existing respiratory disorders
Who is at the highest risk of complications from the flu?
Children/elderly
Pts with pre-existing respiratory disorders
Immunosuppressed persons
Pregnant women
Morbidly obese persons
Who is the flu vaccine recommended for?
all people 6 months and older
What is the treatment for the flu?
Antiviral drugs are available if taken in first 48 hours
Treatment is symptomatic/supportive:
Rest, antipyretics, hydration, cough syrups/drops
What is pneumonia?
Inflammation of the lung parenchyma often due to an infectious agent (typically bacteria)
What are the classifications of pneumonia?
By organism
By distribution of infection
Community or hospital aquirred
What are the risk factors for pneumonia?
Very young/very old
Chronic illness
Prolonged immobility
Immunosuppression
Alcoholism
Malnutrition
Inhalation of fumes or gastric contents
Community acquired pneumonia is?
Infections contracted outside the hospital
S. pneumoniae is most common agent (H. Infkuenzae and S. aureus can also be causes)
What is hospital acquired/nosocomial pneumonia?
Infections that occur 48 hours or more after admission to an inpatient facility
Mostly bacterial (Pseudomonas, S. aureus, Enterobacer, E. Coli)
What is the diagnosis/treatment of pnuemonia?
H&P
Chest Xray
Sputum
Blood Cultures
Appropriate antibiotic therapy
Streptococcal pneumoniae aka pneumococcus is?
A mostly bacterial pneumonia 75% community acquired, with sudden onset
What is streptococcal consolidation?
Fluid or exudate fills groups of alveoli displacing air
Visible on xray, this edema reduces ventilaton and impairs gas diffusion
What are the signs and symptoms of streptococcal pneumonia?
Chills/high fever
Pleural pain
Cough
Bloody sputum
Hypoxemia
Cyanosis (need to be admitted to the hospital)
How is streptococcal pneumonia treated?
with antibiotics, however resistance can occur
What are the 4 stages of streptococcal pneumonia?
Edema
Red hepatization (living tissue looks red and bloody)
Grey hepatization
Resolution
What disease is the world’s foremost cause of death from a single infectious agent?
Tuberculosis
Where is TB more common?
It is more common among recent immigrants from areas with high rates an those living in congregate settings
What is the infectious agent responsible for TB?
Mycobacterium tuberculosis which is a aerobic mycobacteria that is contracted through inhalation of bacilli
What helps prevent destruction of the mycobacterium tuberculosis?
It has a waxy coating that helps prevent destruction plus acid fast bacilli
How is TB spread?
The mycobacterium is exhaled in the respiratory secretions of individuals with active TB
What are the two categories of TB?
Primary/Active TB (10%)
Latent TB(LTBI-90%)
What is primary/active TB?
Previously unexposed and unsensitized person contracts TB
Bacteria is dividing in body, mostly in lungs
Progressive TB is usually symptomatic and infectious
What is latent TB?
The cell mediated response has halted TB replication, TB bacteria are localized in small lesions
Most people develop after Primary TB
Asymptomatic, NOT infectious
What is a Mantoux tuberculin test?
0.1cc PPD of TB is injected intradermally
48-72 hours later, site is examined for induration
What are the cutoffs for the size of the induration diameter?
Size of induration diameter cutoff is based on certain risk factors but is 5mm, 10mm and 15mm to the general public
What is a QuanitFERON-TB Gold test?
A test that measures interferon-y that has a 24 hour result turnaround and can test for LTBI
What is TB treatment?
Antimycobacterial drug treatment:n
A multidrug therapy that lasts for 9 months that eliminates all tubercle bacilli
What is the follow-up after TB treatment?
CXR screens for lung involvement
Can test sputum samples for the mycobacterium
What is the etiology of COVID19?
Infection with SARS-CoV-2 a coronavirus with numerous variants such as Omicron, Delta, etc.
Which variant of Covid-19 spreads the fastest?
Omicron
How are Covid 19 variants named?
Names come from spikes on the virus
What are the types of testing for Covid-19?
Nucleic acid amplification tests (PCR testing)
Antigen testing
What are the 4 Authorized vaccines in the US?
Pfizer (mRNA)
Moderna (mRNA)
Novavax (protein subunit vaccine)
Johnson & Johnson (viral vector)
Type 1 diabetes is?
Diabetes that usually has a juvenille onset where Beta cells are destroyed
Type 2 diabetes is?
The most common type of diabetes with a traditionally adult onset where cells begin to gradually become insulin resistant
What is pre-diabetes?
Patients who have a higher average glucose but is not yet diabetic
What is gestational diabetes?
Pregnancy related diabetes that occurs in 2nd or 3rd trimester
What is the pathophysiology of Type 1 diabetes?
Little or no insulin due to Beta cells in pancreas being destroyed through autoimmune destruction of islet cells
When no insulin is present, the body breaks down fats and proteins
What are the Characteristic of Type 1 diabetes?
Catabolism of muscle
Development of ketosis
Onset in childhood and adolescence
Requires insulin therapy
How is type 1 diabetes normally discovered?
A severe episode normally causes patient to see care
What are the important risk factors for Type 2 diabetes?
Obesity
Fat Distribution (Trunkle obesity=increased risk)
Lack of physical activity
What is the pathophysiology of Type 2 diabetes?
-Gradual insulin resistance of the target cells
-May involve impaired insulin secretion
-Increased glucose production from liver
How insulin secretion impaired in type 2 diabetes?
The body, in response to insulin resistance, will begin to produce more and more insulin and eventually pancreas will ‘give up’ and we will see increased glucagon by the liver
What are the characteristics of Type 2 diabetes?
-Onset usually occurs after age 40
-Often in overweight/obese individuals
-May require insulin therapy if lifestyle changes are not enough to manage
What is the difference in the timing of onset between type 1 and tyoe 2 diabetes?
Type 1-abrupt onset, symptomatic
Type 2-gradual onset, subtle, often asymptomatic
What is Metabolic Syndrome?
A group of problems in body that are all related to impaired metabolism that involve manifestations of abnormal lab values, vital signs, body weight and have a strong association with atherosclerosis and general arterial disease
What are the components of metabolic syndrome?
Increased BP (130/85 or higher)
High Triglycerides (150 mg/dL or more)
Large waistline (Men 40”, Women 35”)
Low LDL(Men 40, women <50)
Elevated fasting blood sugar (100mg/dL)
What are the two most common test for diabetes?
Fasting plasma Glucose
Hemoglobin A1c%
What are the requirements to be diagnosed with diabetes?
2 Fasting plasma glucose levels of >126mg/dL
HbA1C >6.5%
What is the level of Fasting plasma glucose to be considered to have pre-diabetes or impaired FPG?
100-125 mg/dL
What is the HbA1C level to be considered to have prediabetes?
5.7-6.4%
How does a high HbA1C effect circulation?
Erythrocytes get coated in glucose, and makes the RBC stiff, loosing their flexibility which creates circulation problems
What is the monitoring of diabetes?
Pts. self monitor with ‘fingersticks’ for FPG or Random glucose checks
HbA1C checked every 3-4 months
How many people in the US have diabetes?
How many have prediabetes?
34.2 million people (10.5% of US population)
88 million (34.5% of the adult US population)
What are the acute complications of DM?
Diabetic Ketoacidosis
Hyperosmolar Hyperglycemic State
Hypoglycemia
What is the development of Diabetic Ketoacidosis?
Lack of glucose->
Cells break down triglycerides in free fatty acids for gluconeogenesis->
Oxidation of FFA leads to increased ketones->
Metabolic acidosis ensues as the ketones deplete the ECF and cell buffer systems->
Diuresis occurs, loosing K, Na, phosphates and water
What are the manifestations of DKA?
PG>250 mg/dL
Low arterial pH
Kussmaul’s respirations
Acute onset
Malaise
Headache
N/V/D
Stupor
Coma
Hypotension
Tachycardia
What are the manifestations of Hyperosmolar hyperglycemic state?
More common in type 2:
Hyperglycemia (PG>600mg/dL)
Hyperosmolarity (Serum osm >320)
Polyuria->Dehydration
Normal pH levels
(symptoms of a fluid volume deficit)
What is hypoglycemic insulin shock?
Significant drop in plasma glucose
Most common in pts taking insulin
What are the symptoms of hypoglycemic insulin shock?
Headache
Reduced LOC
Seizures/coma
Anxiety
Tachycardia
Diaphoresis
What are the long term complications of Diabetes?
Retinopathy
Nephropathy
Neuroparthy
PAD
MIs
CVAs
Foot ulcers
Increased susceptibility to infections
What is diabetic retinopathy?
Long term elevated blood sugar causes the tiny capillaries in the retina to have ischema
Diabetic nephropathy is?
The most common cause of end stage renal disease where protein leaks into urine starting with microalbumin and leading to hypoproteinemia later
What is diabetic neuropathy?
Nerves no longer transmit properly->
Axonal degeneration due to high PG
Sensory nerve injury precedes motor nerve injury
What is endocrine hypofunction?
impaired development of a gland
What is endocrine hyperfunction?
Excessive hormone production
What is the cause of endocrine hormone resistance?
receptor defects
What are the levels of endocrine disorders?
Primary
Secondary
Tertiary