Lesson 8 Respiratory

Question 1

Respiratory system

Answer 1

Upper respiratory system
Nose, pharynx,

Lower respiratory system
Larynx, trachea, bronchi, lung

Question 2

Respiratory clinical manifestations

Answer 2

Sneezing

Coughing

Dyspnea

Cyanosis

Hemoptysis
Coughing blood or bloody secretion

Question 3

Pulmonary disease clinical manifestations

Answer 3

Pain: pleural pain胸膜
Pulmonary pain (trachea, bronchi inflammation)
Chest wall pain( chest wall muscle sore/ rib fracture)

Clubbing fingers:
Painless, firm, fibrotic enlargement

Abnormal sputum
Yellowish-green (bacteria infection)
Rusty: (pneumococcal pneumonia)

Wheezing

Hypoxemia

Question 4

OPD
obstructive pulmonary disease including?

Answer 4

Asthma
Chronic bronchitis

Question 5

Asthma
Why?
Type
Manifestation

Answer 5

Airway obstructed due to inflammation response to allergens

Acute/ chronic

Dyspnea
Wheezing
Tachycardia
Tachypnea( fast breathing)

Question 6

Parthophysiology of asthma

Answer 6

Bronchi and bronchioles respond to 3 changes
1.mucosa inflammation
2.Bronchoconstriction: contraction of smooth muscle
3. Increased secretion of thick mucus
-) create obstructed airways
-) interfere with airflow and oxygen
-) respiratory acidosis, co2 retention
-) respiratory failure

Question 7

Treatment of asthma

Answer 7

Inhalation of bronchodilator: Salbutamol
Corticosteroids
Non-steroidal drug: leukotriene
Block histamine that form exudate and bronchi constriction
Oxygen therapy

Question 8

COPD
Chronic obstructive pulmonary disease
Cause?
How is the damage?

Answer 8

By progressive degeneration and obstruction of airway

Cause irreversible damage to lung

Question 9

Emphysema is what
Clinical
Cause

Answer 9

Chronically enlarged gas-exchange airway

Loss of elastic recoil
Increased residual volume

Cause: smoking or dusty

Question 10

Chronic bronchitis
What is
Symptoms.

Leads to what

Answer 10

Hypersecretion of mucus snd chronic productive cough for at least 3 months

Mucus is thicker than usual

Chronic irritation and inflammation lead to fibrosis and thickening of bronchial wall and further obstruction.

Question 11

Pneumonia
By What type?
Why
3 types

Answer 11

What: by bacteria, fungal and viral
Why: organism directly enter the lung

Streptococcus pneumonia 肺炎鏈球菌
Pneumococcal pneumonia 肺炎球菌
Viral pneumonia 病毒性肺炎

Question 12

Type of pneumonia
Name
Area
What bacteria/ virus
Partho?
Onset?
Symptoms?

Answer 12

Lobar pneumonia
Area: all of 1-2 lobes
By: streptococcus pneumonia
Partho: inflammation of alveolar wall, leakage of cells, fibrin and fluid into alveoli -) consolidation
Acute onset
High fever snd productive cough, rusty sputum

Bronchopneumonia
Area: small patches
By multiple bacteria
Inflammation and purulent exudate in alveoli
Insidious onset
Mild fever and yellow-green sputum

Interstitial pneumonia
Area: small patches
By Influenze virus mycoplasma
Interstitial inflammation around alveoli
Variable onset
Variable fever and headache, non productive cough

Question 13

Treatment for pneumonia

Answer 13

Ventilation and oxygen
Stay hydrated( 2-3L)
Encourage breathing exercise
Antibiotic for bacterial infection

Question 14

Tuberculosis
Cause by what bacteria?

Patho?

Clinical menifestation?

Treatment

Answer 14

Caused by mycobacterium tubercolosis
First is lung but may invade to other organ e.g. lymph nodes, bone and kidney
Mivrobe survive in dried sputum for weeks

Patho: susceptible person inhaled mycobacteria snd infected
Bacteria transmitted through airway into alveoli
Start multiply
Body’s immune system responds and caused inflammatory reaction.

Clinical menifestation:
May asymptomatic
Low fever, anorexia, weight loss, anxiety

Late stage: dyspnea, chest pain, hemoptysis

Antibiotic
Isoniazid+ rifampin

Question 15

Acute bronchitis

Answer 15

Acute infect of inflammation of the airway
Viral illness
Symptom similar but no pulmonary consolidation

Question 16

Pulmonary vascular disease- pulmoary embolism
Why
Forms what
Where usually have
S/s

Answer 16

Occlusion by tissue fragment or lipid or air bubble
Form thrombus
産科/ 骨科,
Chest pain, dypsnea, increaased rr, pleuritc pain

Question 17

Acute pulmonary distressed syndrome

Answer 17

Respiratory failure with acute lung inflammation
Diffuse alveolocapillary injury
Atelectasis 肺不張
Cause： sepsis/ multiple trauma
S/s: rapid, shallow breathing
Decreased lung compliance
Hypoxemia 低血氧

Question 18

Common drug for respiratory system

Answer 18

Expectorant- easy removal of secretion
MES

Antihistamine- block H1 receptors
Chloepheniramine

Antimicrobials- treatment for infection
Penicillin

Bronchodilator- stimulate b2 receptor to open bronchioles
Ventolin

Question 19

Renal disorder

Answer 19

Renal failure
Nephrotic syndrome
Renal calculus
Glomerulonephritis

Question 20

Genitourinary disorder

Answer 20

Urinary incontinence
Urinary tract infection
Cystitis
Bladder camcer
Prostate disease

Question 21

SUPER IMPORTANT

Clinical manifestation of genitourinary system

Answer 21

Pain commonly in lower abdomen
Dysuria(排尿困難）
Frequency
Urgency
Anuria
Hematuria
Urinary incontinence
Urinary retention

Question 22

Urinsry tract obstruction
Definition
Two types？

Answer 22

Definition： blockage of urinary flow
Striture：narrow is caused by contraction of smooth muscle我stenosis： narrpw is caused by lesion that reduce space in urinar tract

Question 23

Severity of urinary tract obstruction:

Answer 23

Location
Duration
Cause
Completeness

Question 24

Kidney stone
Risk factors
Parthophisiology of stone formation

Answer 24

Risk factors: gender, location, fluid intake
Partho: urinary concentrations such as calcium oxalate, calcium phosphate increase in the urinary tract
Grow into a stone through crystallisation

Question 25

Clinic manifestation of kidney stone
Test？
Treatment？

Answer 25

Manifestation: renal colic 腎絞痛（ intense spasm of pain in flank area.）
Diagnostic test: urogram
Abdominal CT
Treatment: stone removal

Question 26

Urinal tract infection
What is it?
Common pathogens?

Answer 26

UTI is an inflammation of urinary epithelium following invasion and colonisation by some pathogens
Escherichia Coli
Staphylococcus saprophyticus
Enterobacter spp

Question 27

Upper UTI3
Lower UTI3

Answer 27

Upper: pyeolonephritis
Interstitial nephritis
Renal abscess

Lower:
Cystitis
Prostatis
Urethritis

Question 28

Urethritis
Definition
Cause

Answer 28

Definition: inflammation of urethra
Cause:bacteria infection, gonorrhea
Spermicidal jelly
Scented napkin

Question 29

Inflammation process (4)

Answer 29

1.Bacteria invade
2. Attach and colonize the host
3. Evade the host defense mechanism
4. Initiate inflammation

Question 30

Urethritis s/s

Answer 30

Low abdomen pain
Dysuria
Urgency
Frequency
Red, swollen urethra

Question 31

Urethritis treatment (2)

Answer 31

Antibiotics agent (ampicillin)
Urinary analgesic agent( phenazopyridine) (relief burning sensation)

Question 32

Cystitis
Definition
Patho
Manifestation
Treatment

Answer 32

Definition: inflammation of bladder

Patho: ascending bacteria from urethra
Obstructive urinary pattern

Manifestation: dysuria, frequency, urgency, suprapubic pain

Treatment: antimicrobial, increase fluid intake

Question 33

Acute pyelonephritis
Whats happening inside
Cause
Chronic

Answer 33

Acute infection of kidney
Enlarged kidney and even abscess in renal capsule

Cause: upward spread of bacteria
Systemic infection
Urinary tract obstruction

Chronic: repeating acute pyelonephritis
Client with renal infection is more likely to get chronic pyeolonephritis

S/s
Progressive scarring the kidney
Renal failure
Dysuria
Systemic signs appear more on pyelonephritis’s
Urine analysis is similar to cystitis (but have leukocyte)

Question 34

Glomerulonephritis
Definition
Why wui gum?
Patho?

Answer 34

Inflammation of glomerulus
Immune disorder leads to inflammation of glomerulus
Antigen-antibody complex from infection is trapped in glomerulus

Inflammatory damage leads to reduce of function
Increase permeability and cell proliferation
Reduce of protein and erythrocyte

Question 35

Development of glomerulonephritis

Answer 35

1. Streptococcus infection
2. Antibody formation
3. Antigen-antibody complex (few weeks later)
   4.1 Increase permeability-) Hematuria, albuminuria -) recoverable
   4.2 glomerulus swelling, cell proliferation-) congestion, stimulation of renin secretion.
   4.3 glomerulus swelling -) acute renal failure-) recover or die
   Cell proliferation-) chronic glomerulonephritis-) chronic renal failure

Question 36

Chronic gluemrulonephritis patho

Answer 36

Scarring and fibrosis of kidney tissue
Kidney reduced size to its 1/5
Scarring turn surface of kidney rough and irregular
Decrease filtration rate
Chronic renal failure

Question 37

Glomerulonephritis s/s

Treatment?

Answer 37

Urine colour become dark and cloudy
Increased BP(血管多咗嘢
Flank or back pain
Symptoms of inflammation

Treatment:
Sodium restrictor
Glucocorticoids: reduce inflammation
Antihypertensive: reduce BP
Antibiotic: kill bacteria

Question 38

Renal failure
What is it
What affected

Answer 38

Kidney cannot remove metabolism
Affect endocrine and metabolic actions
Affect fluid, electrolye, scid base balance

Question 39

Acute renal failure
what mean?

Answer 39

Rapid loss of renal function
Usually reverisible but prolonged wui irreversible increase serum creatine ( 血管垃圾）blood urea nitrogen
Leads to life threatening ( water & electrolyte imbalance )

Question 40

Renal failure physio and treatment

Answer 40

Progressive reduction of functioning renal tissue
Remaining kidney cannot maintain body internal environment
Need renal replacement therapy

Question 41

Nephrotic syndrome
Partho?
S/s?

Answer 41

A type of renal failure
Partho: abnormal of glomerular capillaries
Manifestation: proteinuria
Hypoalbuminemia
Hyperlipidemia(high serum cholesterol and low density lipid protein

Question 42

Drug in genitourinary system

Answer 42

Urinary analgesic
Analgesic to urinary tract mucosa
Use when pain, burning, itchy sensation

Diuretic
Increase excretion of water and urinary output