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Flashcards in Respiratory Ch22 Deck (21):
1

Describe the transmission of the common cold from one person to another

-aerosol spread of colds through coughing and sneezing is much less important than the spread by fingers to the nasal membrane and eyes.
0-3 days after symptoms onset
incubation 5-7 days

2

Common cold manifestations, and treatment of the common cold

S&S - sore scratchy throat, congestion, watery rhinorrhea, sneezing
malaise, fatigue, headache, myalgia
fever in children, infrequent in adults
self limiting

Treatment
-symptomatic, antihistamines,
decongestants (increases BP)

3

Rhinosinusitis causes, manifestations, and treatment

causes are conditions that obstruct the narrow ostia that drain the sinus
-upper respiratory tract infection
-allergic rhinitis
-nasal polyps
-pressure changes
-decongestant misuse
-swimming/diving
-dental infection

Rhinosinusitis can be classified as
Acute - viral. bacterial(last longer), or both. 5 to 7 days
fungal: rare (immunocompromised)
subacute - 4 to 12 days
chronic - often staphylococcus aureus or allergens 12 weeks

MANIFESTATION
-similar to cold/allergic rhinitis
-facial pain, headache, purulent nasal discharge, decreased sense of smell, and fever, pain in teeth
-chronic (nasal obstruction, sense of fullness in ear, hoarseness, chronic cough, loss of taste and smell. Sinus pain is often absent.
TREATMENT
-antibiotics only if necessary
-intranasal corticosteroids
-topic alpha-adrenergic decongestant (3 days)
-surgery for chronic infections

4

Discuss the cause, transmission. usual manifestation and complications of the influenza virus

-Caused by viruses belonging to orthomyxoviridae family
-Three types A, B, C.
-A and B causes epidemic, C causes upper respiratory infecions in childrens and adults.
-A further categorizes into subtypes.
ANTIGEN drift - RNA segments alter during replication, generating new subtype

TRANSMISSION
-inhalation of droplet nuclei
-1-4 days incubation
-contagious 24 hour prior up to 5 days
-longer for children and immunosuppressed

PATHO
-rapid onset of upper respiratory infection
-virus first targets and kills mucus-secreting, ciliated. and other epithelial cells, leaving gaping holes. which allows extra cellular fluid to escape (runny nose)

MANIFESTATION
-rapid onset of fever and chill
-malaise, muscle aching
-headache, cough, sore throat
-RAPID ONSET

COMPLICATIONS
-viral pneumonia occurs in elderly.
-fever, tachypnea, tachycadia, cyanosis, hypotension, pulmonary fibrosis, death

-sinusitis, otitis media, bronchitis, and bacterial pneumonia.

-reye syndrome (rare but often fatal)
-encephalitis & liver diease
-no aspirin for children

5

Discuss rationale for influenza immunization

-vaccine is altered yearly
-effectiveness depends on age. accuracy of prediction of virus strain and immunocompetence
-recommend for 50 and older, chronic health, immunosuppressed, high risk environment

-not recommend for <6 month, hypersensitive to components of vaccine

-acute febrile, or history of Guillain-barre syndrome

6

Discuss the etiology and manifestation of primary atypical pneumonia

Causes
-viral and mycoplasma infections that invade the alveolar septum and the interstitium of the lung
-mycoplasma pneumoniae

MANIFESTATION
-patchy lung involvement
-moderate amount of sputum, moderate elevation of WBC, lack of alveolar exudate.

causes damage to the lung epithelium

7

What are the difference in community-acquired and hospital-acquired pneumonia in terms of cause and pathogens

COMMUNITY
-infections from organisms found in the community. Before 48 hours admitting to the hospital.
-bacterial or virus. Most common is streptococcus pneumoniae
-H influenza
-Staphylococcus aureus
-gram negative bacilli

HOSPITAL
-acquired 48 hours in hospital
-lower respiratory tract
-usually bacteria
-psudomonas aeruginosa
-staphylococcus aureus
-enterobacter
-klebsiella pneumoniae
-escherichia coli
-seratia
-many acquired antibiotic resistance so difficult to treat

8

Discuss risk factors, cause and manifestations of of acute bacterial pneumonia in PNEUMOCOCCAL PNEUMONIA

Acute Bacterial
-risk factors include:
-loss of cough reflex
-damage to endothelium/cilia
-impaired immunity
-antibiotic therapy
-diabetics

PNEUMOCOCCAL PNEUMONIA
-most common bacterial
-streptococcus pneumoniae
-organism attaches & colonizes in mucous membrane of nasopharynx, but may not progress

-Polysaccharide capsule prevents, delays digestion by phagocytes
-asplenic person at risk for bacteremia becuase spleen eliminates organisms

MANIFESTATION
-depends age, health status
-sudden
-fever, malaise, chills
-initial productive cough/watery sputum, progressing to blood tinged
-decreased air entry
-pleuritic pain
-fever subsides with treatment
-elderly may not have temp change, only loss of appetite and mental status

9

Discuss risk factors, cause and manifestations of of acute bacterial pneumonia in LEGIONNAIRE DISEASE

-Caused by gram-negative, legionella pneumophila
-inhalation of aerosolized contaminated water or soil (not airborn). Air-conditioners

MANIFESTATION
-rapid onset
-malaise, weakness, lethargy, fever and dry cough
-diarrhea
-CNS alteration
-arthralgia
-hyponatremia and confusion

10

Differentiate between primary tuberculosis and reactivated tuberculosis on the basis of pathophysiology, risk factors, manifestations, diagnostic measures and treatment

Primary
-person is previously unexposed
-asymptomatic, latent phase
-granuloma surrounds bacilli and limits spread, not contagious

RISK
-living in country with high incidence
-crowded/confined living conditions
-immunocompromised

MANIFESTATION
-5% may progress to active infection
-insidious but can be abrupt
-fever, pleuritis, weight loss, fatigue, night sweats, cough, dyspnea
-hematogenic disseminatiom is when tuberculosis eroding into the blood vessel (RARE)

REACTIVATED
-reinfection from inhaled droplet or reactivation of a previously healed primary lesion
-due to impaired body defenses
-cell-mediated hypersensitivity response is aggravating factor, evidenced by caviation

MANIFESTATION
-low grade fever, night sweats, easy fatigued, anorexia. weight loss, dry cough, blood tingued, dyspnea, orthopnea
COMPLICATION: pleural effusion

PATHOLOGY
-infected droplet inhaled settles in alveoli, macrophages engulf bacilli, bacilli multiplies, macrophages burst.
-this process invites more lymphocytes and fibroblasts that surrounds bacilli and form a granuloma (ghon complex)
-lympocyes are activated in a delayed hypersensitivity reaction releasing cytokines that can kill bacilli. (lung tissue damaged in process)

DIAGNOSIS
-identification of the organism from culture or identification using M.tuberculosis amplification techniques
-chest radiographs

-TB test is the result from a cell-mediated immune response. Implies that a person has been infected with M.tubeculosis and has mounted a cell-mediated response

TREATMENT
-isoniazid (INH), ethambutol (EMB), pyrazinamide (PZA), and rifampin.

-prophylactic treatment for those who has latent tuberculosis- INH used

-mutate and become resistant to any drug

11

What are risk factors associated with lung cancer

-smoking
-chemical toxins (asbestos, arsenic, chromium, nickel, vinyle-chloride dust

12

Describe small cell lung cancer in terms of pathology and prognosis

-small to round oval cells
-highly malignant
-rarely seen in non-smoker
-paraneoplastic disorder is common such as the syndrome of the inappropriate antidiuretic hormone

13

Describe non-small cell lung cancer's pathology and prognosis

Squamous Cell
-common in men and smokers
-central bronchi initially, early detection from sputum and treatment
-metastasize slow
-paraneoplastic syndrome is hypercalcemia

Large Cell
-large polygonal cells
-involves periphery of lungs
-metastasizes early

Adenocarcinoma
-common in North American, women, and non-smokers
-associated with scarring and previous injury such as infarcts, wounds, foreign bodies
-poorer prognosis than squamous cells because metastasize easy
Paraneoplastic disorder is hematologic disorders


14

Describe the typical manifestations, diagnostic measures, and treatments methods for lung cancer

typical manifestation are cough, wheezing, SOB

-Diagnosis
CXR
Bronchoscopy
Sputum/bronchial washing cytological studies
Needle biopsy of lung tissue
Lymph node biopsy
CT/MRI/US/PET

-Treatment
Symptoms
Lobectomy
Radiation/chemotherapy

15

Discuss respiratory distress syndrome in terms of risk factors, pathogenesis and manifestation

-hyaline membrane disease, very common in premature infants due to surfactants deficiency and pulmonary immaturity
RISK FACTORS
- Prematurity
Male
Caucasian
Diabetic mom – insulin inhibits surfactants protections in utero
Difficult deliveries (asphyxia, cold, etc.)
C-section + prematurity
*cortisol increases surfactant production

PATHO
-lack of surfactant causes large alveoli to stay open, small cannnot open
-Hyaline membrane forms
Proteins/fibrin pulled from circulation
Decreased area of gas exchange
Lung stiffens

MANIFESTATION
-Central cyanosis
Dyspnea
Retraction in chest wall
Grunting sounds with expiration
RR rises 60-120/min
Tidal volume falls
Fatigue
Patent ductus arteriosus

16

Describe bronchopulmonary dysplasia in terms of risk factors, pathogenesis, and manifestation

Chronic lung disease as a result of:
Mechanical ventilation (d/t other disease)
Prolonged oxygen supplementation


Alveolar hypoplasia and fibrosis

PATHO
-interference with normal lung maturation, prevent growth and development of lungs and heart
-Natural antioxidants are immature and unable to neutralize free radicals formed as a result of oxygen use by body

MANIFESTATION
-Hypoxemia, hypercapnia
Tachypnea, chest retraction, cough
Tachycardia

Clubbing, peri-orbital edema (RHF)
Hepatomegaly
Lung injury result in unstable growth of pulmonary/cardiac vasculature
Poor weight gain


17

Differentiate between upper and lower airway infections in children and name conditions under each catergory

-Upper Airway infections (prolonged inspiration)
Viral Croup
Spasmodic Croup
Epiglottitis

-Lower Airway Infections
Prolonged expiration
Bronchiolitis

18

Describe the cause, manifestations, and treatment for viral croup

-acute laryngotracheobronchitis, viral infection that affects the larynx, trachea, and bronchi.
-subglottic area is narrowest
-3 month to 5 years

MANIFESTATION
-barking cough, inspiratory stridor, hoarseness

TREATMENT
-moist or cold air
-decrease stimulation
-monitor for obstruction
-administer racemic epinephrine and airway

19

Describe the cause, manifestations, and treatment for spasmodic croup

-similar presentation excepts no signs of viral infection
-allergic origin
-occurs at night

TREATMENT
-cold humidification

20

Describe the cause, manifestations, and treatment for epiglottitis

-inflammatory edema of the epiglottis and pharynx, sudden airway obstruction
-streptococcus pyogenes, staphylococcus pneumoniae, and S.Aureus

MANIFESTATION
-pale, lethargic, mouth open, chin forward
-difficulty swallowing, speaking
-fever, anxiety
-respiratory distress

TREATMENT
-endotracheal tube or tracheostomy
-antibiotics

21

Describe Bronchiolitis and manifestation

-viral infection of the lower airway, causes inflammatory obstruction of the small airways and necrosis of the cells lining the lower airways
-respiratory syncytial virus
-history of mild upper airway infection

MANIFESTATION
-prolonged expiration, wheezes, dyspnea, and resulting hypoxemia