Respiratory Disorders Flashcards
Influenza: What type of infection? Where? What types of influenza are there? Which is most common? Incubation period? Who does it affect the most?
Acute viral infection. URT. A B C, A most common. 1-4 days. Elderly, young, health care workers, chronically ill.
What is the patho for influenza? What happens if it extends to the LRT?
Virus and inflammation - tissue damage of epithelial cells. Bronchial and alveolar damage.
What are 3 complications of influenza?
Secondary bacterial infection, bronchitis or pneumonia.
What are 4 manifestations of influenza? Prophylactic measure? 3 treatment methods?
Cough, fever, lethargy, myalgia. Immunization. Prevent spread to others/LRT, symptomatic treatment, and antivirals.
What two types of antivirals are there for influenza?
Amantadine (1st generation) - prevents uncoding of genetic material. Relenza (2nd generation) - prevents replication of virus and lyse of cell.
What is another name for pneumonia? What structures are inflamed in this disease? What two forms are there? How can pneumonia be classified?
Pneumonitis. Alveoli and bronchioles, distal part of the respiratory tract. Infectious and non-infectious. By infectious agent or area of lung affected.
What are 5 etiologic factors for pneumonia and what categories can they be divided into?
Bacteria, virus, fungi (infectious pneumonia). Aspiration and noxious fumes (non-infectious pneumonia).
What is the patho for pneumonia? What two problems arise in the patho of pneumonia?
Impaired resp defences - agent enters RT and proceeds to lungs. Inflm - pulmonary edema (exudate) - impaired gas exchange due to increased diffusion distance. 1. inflm and tissue damage 2. exudate formation.
What is typical pneumonia? Atypical pneumonia? Bronchopneumonia? Lobar pneumonia?
Microbe activity within alveoli (bacterial). Microbe activity in tissue of lungs (viral). Diffuse inflammation (throughout lung). Lobe/part of lobe affected by pneumonia.
What are 7 manifestations of pneumonia?
Fever and chills, dyspnea, sputum (exudate and mucus), headache, myalgia, lethargy, and chest pain.
How is pneumonia diagnosed? Treatment?
CXR, sputum C + S. Abx and supportive treatment (oxygen).
What is COPD? What two diseases is it comprised of?
Persistent inflammation of airways, parenchyma and vasculature in RT resulting in obstruction. Chronic bronchitis and emphysema.
What are 4 etiology/risk factors for COPD?
Smoking, recurrent respiratory infections, ageing, and genetic deficiency in alpha 1 antitrypsin.
What 4 roles does cigarette smoke play in the RT?
Increases mucus secretion, damages cilia, causes inflammation leading to tissue damage, induces coughing.
What is chronic bronchitis?
Inflammation and obstruction of airways due to smoking and chronic/recurrent infections.
What are the two characteristics/changes in chronic bronchitis? What change happens in the large airways first and then small airways?
Large airways: hypertrophy of submucosal glands - increased mucus secretion/hypersecretion of mucus. Small airways: increase goblet cell number - increased mucus production.
What is the patho for chronic bronchitis? In the V:P ratio, which factor is affected?
Excess mucus - mucocilary defences impaired - infection occurs easier - bronchial wall inflm - lumen obstruction - airway collapse (air is absorbed) - decreased alveolar ventilation - ventilation:perfusion (v:p) imbal - hypoxemia. V is affected.
How is chronic bronchitis diagnosed?
Chronic productive cough >3 mos/year for 2 consecutive years.
What are 6 manifestations of chronic bronchitis?
hypoxemia and hypercapnia, activity intolerance, ++ sputum, dyspnea, wheezing and crackles (wet), prolong expiration.
What is emphysema? What does it result in in terms of gas exchange?
Destruction of alveolar tissue and capillary beds causing loss of compliance - damaged elastic tissue. Decreased surface area for gas exchange.
What are two etiologic factors for emphysema?
Smoking, genetic deficiency of a1 antitrypsin.
How does a genetic deficiency for a1 antitrypsin play a role in emphysema?
a1 antitrypsin is an inhibitor for proteases and elastases, with it being deficient, proteases and elastases are free to break down alveolar walls.
What is the patho for emphysema?
Smoking inhibits a1 antitrypsin (inhibiting inhibitors). Smoking attracts inflammatory cells - tissue damage. Increase proteases - destruction of alveolar wall and wall of a/w - alveoli merge - decrease SA - decrease fx - air traps in between alveoli - increased dead space - increased WOB. Capillary walls destroyed - impaired perfusion.
In the V:P ratio for emphysema, which factor(s) is affected?
V and P
What is a “bullae”? “Bleb”?
Dead space pushing upward against pleural membrane. Smaller form of bullae.
What is centriarcinar emphysema? Panacinar emphysema? Which is more common?
Terminal bronchioles and respiratory bronchioles are damages, alveoli largely intact. Alveoli and terminal airways affected. Centriarcinar.
What are 3 manifestations of emphysema?
Dyspnea, increased ventilation effort (pursed lip breathing, nasal flaring, use of accessory muscles), and barrel chest (long term).
What three diagnostics are used to diagnose COPD?
ABGs, CXR, pulmonary fx tests.
What three things can be done to manage progression of COPD?
No smoking, avoid a/w irritants, flu and pneumococcal vaccines.
What is the treatment regimen for COPD?
Short acting B agonist (1st line approach) and anticholinergics (bronchodilation)… then add inhaled steroid… then take away short acting B agonist and add long acting B agonist. Theophylline (bronchodilator with anti-inflm properties).
What two strains of bacteria cause TB? How is each spread?
Myobacterium tuberculosis hominis: human TB, spread via coughing, sneezing, talking, droplet nuclei. Myobacterium tuberculosis bovine: bovine TB, spread via milk from infected cow, initially affects GIT.
What is the Ghon focus? What is it comprised of?
Primary lesion. Bacillus, macrophage and other immune response cells.
What is the Ghon complex?
Primary lung lesion (Ghon focus) and lymph node granulomas
In primary TB what occurs first before the cell-mediated IR?
The bacillus enters the alveolar sacs and is engulfed by a macrophage but the macrophage is unable to phagocytize the bacillus because of the wall lipids.
During the cell-mediated IR of primary TB what happens?
The macrophage presents the Ag to T lymphocytes in a regional lymph node - the T lymphocyte becomes sensitized and stimulated the macrophage to increase it’s lytic enzyme concentration - this results in destruction of bacillus and lung tissue - forming the primary lesion
When the numbers of the bacillus increases in primary TB what sort of a reaction occurs? What happens to the Ghon focus?
Hypersensitivity reaction. Central portion of Ghon focus undergoes soft, caseous necrosis (cheeselike death).
What occurs when the Ghon focus undergoes necrosis in primary TB? What is formed?
Tubercule bacillus drain along lymph channels affecting the tracheobronchial lymph nodes. Formation of caseous granulomas (lymph node granulomas).
How does secondary TB occur? What is usually the aggravating factor causing cavitation and bronchial dissemination?
Reinfection or reactivation from a healed primary lesion. Cell-mediated hypersensitivity reaction.
What are 4 manifestations of TB? Which manifestation is specific to secondary TB?
Wt loss, low grade fever, night sweats, fatigue. Low grade fever
What are two screening methods for TB? How is it diagnosed?
TB test, CXR. Sputum C+S, genotyping (identify the strain).
Which vaccine is given to people at high risk for TB? What is one odd treatment method used for TB that one would not expect? What are 5 other treatments?
Bacillus Calmette-Guerin (BCG) vaccine. Chemotherapy. Rifampin (inhibit RNA synthesis), ethambutol (inhibit growth), isoniazia (INH), pyrazinamide (PZA - inhibit growth), streptomycin.
What nasal passages are affected in rhinosinusitis?
Frontal, ethmoid, and maxillary sinuses.
What is the patho for rhinosinusitis?
Viral URTI or allergic rhinitis - obstructs ostia that drains sinuses - impaired mucociliary clearance mechanism
How is rhinosinusitis diagnosed? What are 3 treatment options?
Transillumination, CT scan. Abx, mucolytic agents, symptomatic treatment.
What are 2 orbital complications of rhinosinusitis? What are 5 intracranial complication?
Edema of eyelid and orbital cellulitis. Facial swelling, abnormal extraocular movements, protrusion of eyeball, periorbital edema, change in mental status.
What 5 virus strains are responsible for the common cold?
Rhinovirus, parainfluenza virus, respiratory syncytial virus (RSV), coronavirus, and adenovirus.
What is the MOT of viruses for the common cold? What are 4 manifestations of the common cold?
Contact and aerosol spread. Headache, general malaise, excessive nasal secretions, tearing of eyes.
Which OTC remedies for the common cold are perhaps beneficial when taken immediately as manifestations appear? Which other OTC remedies are there? Do any of them shorten length of illness?
Echinacea. Antihistamine (dry nasal secretions) and decongestants (constrict BV in nasal passage to decrease swelling). Vitamin C, Zinc. No.
What is asthma?
Reversible episodes of a/w obstruction d/t inflm and muscle hyperactivity
