Lecture 6 Respiratory System Part 2

Question 1

Describe the pathologies and clinical feature of allergic rhinitis.

Answer 1

Types:
1. Seasonal e.g. Hay Fever
2. Continual caused by dust, mold, colognes, cigarette smoke, animal dander and mites.

Clinical features:
Sneezing, itchy, watery eyes, redm swollen eyelids, congested nasal mucus membranes and nasal discharge

Treatment:
1. Antihistamines and decongestants
2. Avoid known allergens
3. Air filters and air con can keep down allergen counts
4. Allergist can giving desensitization injections for long term management.

Question 2

Describe the pathologies and clinical feature of Sinusitis (鼻竇炎).

Answer 2

Types:
1. Acute
2.Chronic

Pathologies:
Inflammation of the membranes lining the sinuses.
bacterial predominantly, excess mucus production in sinus, blockage of sinus openings, and the destruction of cilia that move mucus out of the sinus.

Clinical feature:
Headache, facial pain, tooth pain, nasal congestion, fever, pharyngitis and cough

Treatment:
1. Nasal decongestants, nasal steroid sprays, humidifier, analgesics for pain and antibiotics
2. Sinus lavage (washing) to clear the sinus.
3. Surgery may required

Question 3

Describe the pathologies and clinical feature of Upper respiratory tract infection.

Answer 3

Pathologies:
1. Common cold including pharyngitis
2. Caused by a family of viruses — rhinovirus
3. Viruses become airborne through respiratory droplets
4. Transmitted by contact with contaminated surfaces and objects
5. Self-limiting condition approximately one week duration.

Clinical Feature:
1. Pharyngitis, nasal congestion, rhinitis, rhinorrhea (流鼻涕), headache, fever and general malaise.

Treatment:
1. Antipyretics, analgesics, decongestants and antitussives
2. Full of rest and plenty of fluid

Question 4

Describe the pathologies and clinical feature of Influenza.

Answer 4

Pathologies:
1. Commonly called — Flu
2. The upper and lower respiratory tracts are infected
3. Caused by a number of different virus

Clinical feature:
Headache, fever or chills, dry cough, malaise (身體不適), myalgia (肌肉痛), fatigue, anorexia (厭食症), sneezing, rhinorrhea, pharyngitis and diarrhea

Treatment:
1. Analgesics (鎮痛藥)and antipyretics (退燒藥) can ease the aches and pains and fever.
2. Bed Rest, fluid and antiviral medications

Question 5

Describe the pathologies and clinical feature of laryngitis

Answer 5

Aetiology:
virus, bacteria, polyp in pharynx, excessive talking, shouting, singing, allergies, smoking, frequent heartburn, frequent use of alcohol, damage to nerves that supply the larynx, stroke that paralyze vocal cord muscle

Clinical features:
1. Dysphonia and tickling sensation in the throats
2. Dry throat
3. Pharyngitis

Treatment:
1. Voice rest
2.Management of heartburn
3. Avoidance of cigarettes and alcohol
4. Antibiotic
5. Surgical removal of laryngeal polyp and tighten the vocal cord

Question 6

Describe the pathologies and clinical feature of Asthma

Answer 6

Pathologies;
Chronic inflammatory condition of airways.
Most common chronic disease in childhood.
Adult-onset asthma is also probable.

Clinical feature:
1. Wheeze
2. SOB
3. Cough
4. Chest tightness

Pathophysiologically:
1. Airway hyper-responsiveness
2. Bronchial inflammation
3. Reversible airflow limitation

Diagnosis:
1.Compatible clinical history
2. ??? refer to lecture

Treatment:
1. Avoid aggravating factor
2. Medication (Blue — reliever, Orange — preventer, Green — symptom controller, Purple — combination medication)
3. First aid for asthma: 4 puffs of blue reliever (4 breaths 1 puff)–> wait 4 mins and repeat the process –> call the ambulance after 2 round no improvement

Question 7

Describe the pathologies and clinical feature of Acute Bronchitis

Answer 7

Pathologies:
Caused by the same viruses that cause common cold

Clinical feature;
Chills, fever, coughing up of yellow-gray or green mucus, tightness in the chest, and dyspnea

Treatment:
Rest, fluild, cough medicine and the use of humidifier

Non-infectious cause:
Gastroesophageal reflux disease, exposure to cigarette smoke, pollutants and the fumes of household cleaners

Question 8

Describe the pathologies and clinical feature of Mesothelioma (胸腔間皮瘤).

Answer 8

Pathologies:
Cancer affects the pleura
Exposure to asbestos(石棉) fibers in the workplace or home.

Clinical feature:
Low back pain, shortness of breath, persistent cough and difficulty swallowing and weight loss

Treatment:
Surgery, chemotherapy, radiation therapy

Question 9

Describe the pathologies and clinical feature of Pleuritis.

Answer 9

Pathologies:
Pleura become inflamed

Ateology:
Viruses bacterial, post-pneumonia, autoimmune disease such as lupus or rheumatoid arthritis, tuberculosis, pulmonary embolism and trauma to the chest

Clinical feature;
1.SOB
2. Cough
3. Fever and chills
4. Chest pain

Question 10

Describe the pathologies and clinical feature of Pleural effusion (胸腔積液).

Answer 10

Pathology:
Overproduction of pleural fluid or inadequate absorption of the fluid.
The fluid builds in the pleural space, the lung begin to compress, reducing the gas exchange of o2 and Co2.

Aetiology:
Congestive heart failure, cirrhosis, tuberculosis, cancer, lupus(狼瘡), kidney failure and rheumatoid arthritis

Addition:
Infection processes may result in a pus buildup — empyema

Treatment:
1. Thoracocentesis can remove the fluid or pus.
2. Thoracostomy can help maintain drainage of the acute phase of the illness
3. Oxygen maybe administered to increase oxygen concentration in the lungs
4. Antibiotics may be given for any existing bacterial infection

Question 11

Describe the pathologies and clinical feature of Atelectasis(Collapsed lung).

Answer 11

Aetiology:
1. Abdominal or thoracic surgery
2. Thorax effusion
3. injury to the ribs or trauma to the thoax
4. Postsurgical patients
5. Cancer patients and those with inflammatory conditions such as pleurisy, COPD or cystic fibrosis

Clincial feature;
1. Dyspnea, cyanosis, diaphoresis, anxiety, tachycardia and intercostal muscle retraction

Treatment:
1. Thoracocentesis
2. Chest percussion
3. Postural drainage
4. Coughing
5. Deep breathing exercises
6. Intermittent positive-pressure breathing

Addition:
Air = penumothorax
Blood = haemothorax
Fluid = hydrothorax
Pus = pyothorax

Question 12

Describe the pathologies and clinical feature of COPD (Chronic obstructive pulmonary disease).

Answer 12

Pathology:
Chronic inflammatory response in the airways and lung.
Persistent airflow limitation to the lungs
Progressive
Little or no reversibility
Exacerbation （急性發作）and comorbidities increase the severity.

Clinical Features:
1. Smoking or occupational exposure
2. Older than 40 years old
3. Dyspnoea
4. Cough
5. Wheeze
6. Sputum production (咳痰) (clear/ white)

Investigation:
1. Lung function test
2. CXR and CT scan
3. Blood gases

Treatment:
1. Stop Smoking
2. Medications: bronchodilators, anticholinergics, corticosteroids, antibiotics
3. Pulmonary rehab
4. Oxygen therapy

Question 13

Describe the feature, clinicial diagnosis and clinical feature of chronic bronchitis?

Answer 13

Feature:
Inflammation & excess mucus.

Clinical diagnosis:
daily productive cough for three months or more and at least 2 consecutive years.

Clinal feature:
1. Overweight and cyanotic
2. Elevated Hemoglobin
3. Peripheral edema
4. Rhonchi and wheezing

Question 14

Describe the feature, pathological diagnosis and clinical feature of emphysema?

Answer 14

Feature:
Alveolar membranes break down.

Pathologic diagnosis:
Permanent enlargement and destruction of airspaces distal to the terminal bronchiole

Clinical feature:
1. Older and thin
2. Sever dyspnea
3. Quiet Chest
4. X ray: hyperinflation with flattened diaphragm

Question 15

Describe the feature, pathological diagnosis and clinical feature of COPD?

Answer 15

Investigation:
1. Lung function tests (Decrease FEV1: FVC & PEFR)
2. CXR (hyperinflation) and CT Scan
3. Blood gases

Treatment & management:
1. Stop Smoking
2. Medication (Bronchodilators, anticholinergics, corticosteroids, antibiotics)
3. Pulmonary rehabilitation
4. Oxygen therapy

Question 16

Describe the feature, pathological diagnosis and clinical feature of Pneumonia?

Answer 16

Pathology:
Inflammation & infection of the lungs

Aetiology:
1. Common bacterial also caused by viruses and fungi
2. 50% of pneumonia is pneumococcal
3. Types: Lobal pneumonia, bronchopneumonia
4. Classification: CAP, HAP and atypical

Clinical feature:
1. Acute: Cough, purulent, sputum, SOB and fever
2. Physical signs or radiological changes compatible with consolidation of the lung.

Question 17

Describe the feature, pathological diagnosis and clinical feature of Lung Cancer & Bronchial carcinoma (支氣管癌)?

Answer 17

Aetiology:
1. Cigarette smoking

Clinical feature:
1. Cough that worsens over time, hemoptysis(咳血), dyspnea, wheezing, shortness of breath and recurrent bronchitis
2. Chest pain, dysphonia, unexplained weight loss, bone pain if cancer spread

Treatment:
1. Chemotherapy
2. Radiation therapy
3. Surgical removal of tumors
4. Lobectomy
5. Pneumonectomy

Question 18

Describe the feature, pathological diagnosis and clinical feature of Pneumoconiosis?

Answer 18

Aetiology:
1. Long time exposure to different environmental or occupational types of dust.

Types of Pneumoconiosis:
1. Anthracosis: Exposure to coal dust
2. Asbestosis: Exposure to asbestos
3. Silicosis: Exposure to silica sand from sand blasting and ceramic manufacture

Pathology:
Fibrosis tissue takes over healthy lung tissue, which destroys the alveoli and eventually the bronchioles.

Clinical feature:
1. Tachypnea (呼吸急促), productive cough, progressive dyspnea on exertion, pulmonary hypertension, recurrent respiratory infection, and eventual right ventricular hypertrophy

Treatment:
1. Avoiding the causative dust
2. preventing respiratory infections
3. Bronchodilators
4. Supplemental oxygen

Question 19

Describe the feature, pathological diagnosis and clinical feature of Pulmonary Oedema?

Answer 19

Pathology:
1. Fluids fill the alveoli of the lungs making gas exchange difficult or even impossible

Aetiology:
Left heart failure, myocardial infraction, cardiomyopathy, heart valve disorders, lung infections, allergic reactions, smoke inhalation, drowning, various drugs such as narcotic and heroin, chest injuries and high altitudes

Clinical feature:
1. Shortness of breath, orthopnea, crepitant rales, productive cough that produces clear/ pink mucus, rapid weight, pallor and diaphoresis

Treatment:
1.Oxygen therapy
2. Diuretics (利尿劑) to eliminate excess fluids
3. Morphine to reduce anxiety and shortness of breath

Question 20

Describe the feature, pathological diagnosis and clinical feature of Pulmonary Embolism?

Answer 20

Pathology:
1. A complication of DVT. Blood clot that has broken loose from a vein in the legs.

S&S:
1. Sudden dyspnea
2. Tachypnoea
3. Tachycardia
4. Fever
5. Chest pain
6. Haemoptysis

Diagnosis:
Pulmonary CT angiography

Treatment:
1. Support stockings can be used to promote lower limbs circulation
2. Thrombolytic medication and anticoagulants
3. Surgery: place a filter in the vena cava to prevent blood clots from reaching the lungs