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Flashcards in Respiratory Disorders Deck (60)
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1

Transmission of the Common Cold

Person to person
Fingers
Children
Portal of entry - nasal mucosa and conjunctival surface of eye
Three days after onset of symptoms = most contagious
Incubation 5 days
Survive more than 5hr on skin and surfaces

2

Common Cold: Causes

Viral infection of the upper respiratory tract
Rhinovirus, parainfluenza, syncytial, coronaviruses, adenovirusess

3

Common Cold: manifestations and treatment

Sore scratchy throat
Profuse and watery rhinnorhea
Congestion
Sneezing and coughing
Malaise and fatigue
Headache

Rest
Antipyretic for children
OTC symptom management

4

Rhinosinusitis: causes

Conditions that obstruct or narrow the Ostia that drain sinuses
Viral upper respiratory tract infection or allergic rhinitis
Nasal polyps
Barotrauma
Swimming
Decongestant abuse
Dental infection

5

Rhinosinusitis: manifestations and treatment

Similar to common cold
Acute - rhinitis, facial pain, headache, purulent nasal drainage, fever, pain on bending
Chronic - nasal obstruction, fullness in ears, post nasal drip, hoarseness, chronic cough, loss of taste and smell, dull constant headache

Antibiotics
Intranasal corticosteroids
Mucolytic agents
Symptom relief

6

Influenza: Etiology

Viruses in the orthomyxoviridae family
A and B cause epidemics C is a mild infection

Antigen drift - rna alters during replication generating new H and N subtypes
Population is partially protected due to previous immunity
Epidemics

Antigen shift - rna recombination replaces both H and N antigens leaving all individuals susceptible
Pandemics

7

Influenza: transmission

More contagious than bacterial infections
Inhalation of droplet nuclei
Not contact
Infectious from 24hr before symptom onset to 5-10 days after sumps appear
1-4 day incubation

8

Influenza: pathogenesis

Healthy person - upper respiratory tract infection
Viral pneumonia
Viral leading to susceptibility to bacterial pneumonia

Attacks mucous secreting cells and epithelial cells damaging to expose basal layer allowing ECF to escape
Further down the bronchial tree secretions thicken promoting bacterial adhesion
Severe shedding of bronchial and alveolar cells
Promotes bacterial adhesion

9

Influenza: manifestations

Abrupt onset
Fever
Chills
Rapid onset of profound - Malaise
Muscle aching
Headache
Profuse watery nasal discharge
Nonproductive cough
Sore throat

Weakness cough and malaise may persist for weeks after resolution

Children - fever and febrile convulsions

10

Influenza: complications

Viral pneumonia - rapid progression of fever Tachypnea, cyanosis, hypotension, pulmonary fibrosis and death

Secondary complications - sinusitis, otitis media, bronchitis

Bacterial pneumonia - feeling better before return of fever, shaking, chills, chest pain, productive cough

Reye sydrome - rare complication in children given aspirin
Fatty liver and encephalitis

11

Influenza: immunization

Changed yearly in response to prediction
Effectiveness depends on age and immunocompetence and accuracy of prediction
Reduces severity and likelihood of catching it

Recommended - over 6months, high risk people, over 50, chronic health issues, immunosuppressive

Contraindicated - less than 6months, anaphylactic hypersensitivity, acute febrile illness, history of guillain barre syndrome

12

Pneumonia

Inflammation of parenchyma structures of the lung; lower lungs

Typical or atypical lobar or bronchopneumonia community or nosocomial

Risk factors - impaired host defences, chronic lung disease, airway instrumentation, mechanical ventilation

13

Community acquired pneumonia

Outside the hospital or dx within 48hr after admission

Bacterial or viral
Streptococcus pneumoniae
Haemophilus influenza
Staphylococcus aureus
Gram negative bacilli
Etc

14

Hospital acquired pneumonia

After 48hr in hospital
Can determine from previous cultures and know which antibiotics have been effective

Bacteria
Pseudomonas aeruginosa
Staphylococcus aureus
Enter after species
Klebsiella pneumoniae
Escherichia coli

15

Acute Bacterial Pneumonia (Typical)

Lobar - consolidation of part of all of a lobe
Bronchopneumonia - more than one lobe patchy

Lung below main bronchi is normally sterile despite frequent air entry of microorganism

Risk Factors:
Loss of cough reflex
Damage to ciliates endothelium
Impaired immune defences
Antibiotic therapy
Diabetes
Smoking
Chronic bronchitis
Viral infections

16

Acute Bacterial Pneumonia: Pneumococcal Pneumonia

Most common
Streptococcus pneumoniae - attaches and colonized in mucus membranes of nasopharynx, but may not progress and will be carriers

Pyrogenic infection of the lungs, ears, sinuses, and meninges

Polysaccharide capsule - prevents digestion by phagocytes

17

Acute Bacterial Pneumonia: Pneumococcal Pneumonia
Manifestations and risk factors

Malaise, severe shaking chills, fever, watery sputum, limited breath sounds, fine crackles, pleuritic pain,
Sputum may become blood tinged to purulent

Asplenic person
Children with sickle cell

18

Acute Bacterial Pneumonia: Legionnaire Disease

Legionella pneumonphila

Transmission occurs when stagnant water containing the pathogen is aersolized into droplets and inhaled
Not airborne or person to person

19

Acute Bacterial Pneumonia: Legionnaire Disease
Manifestations and risk factors

Rapid onset - malaise, weakness, lethargy
Fever, dry cough, diarrhea, confusion, arthralgia, hyponatremia
Consolidation of lung tissues
Lack of normal temp pulse relationship

20

Tuberculosis: risk factors

Mycobacterium tuberculosis

Airborne droplet nuclei
Waxy cell wall - increases resistance to antibiotics and disinfection; slow to grow
Aerobic

Living in a country with high incidence
Crowded confined living conditions
Immunocompromised

21

Tuberculosis: Pathogenesis

Infected droplet nuclei inhaled and settles in alveoli
Macrophages engulf the bacilli and initiate cell mediated immune response - cannot completely kill
Bacilli continue to multiply
T-lymphocytes are activated in delayed hypersensitivity reaction releasing cytokines that kill bacilli and damage lung tissue

Ghon focus - circumscribed granuloma toys lesion containing remaining live and dead bacteria and immune cells

Ghon complex - combination of primary lung lesion and lymph node granulomas

Casious necrosis - [Continuous multiplication and cope of dead cells

22

Primary Tuberculosis: risk factors and manifestations

Forms in person previously unsensitized
Often asymptomatic and will develop latent TB - not active or transmissible

Risk factors: immunocompromised and very young children

Manifestations
Insidious onset
Fever
Pleuritic pain
Weight loss
Fatigue
Night sweats
Cough
Dyspnea
Hematogenic dissemination - rare erosion of a blood vessel and transmission to other areas

23

Reactivated Tuberculosis: risk factors and manifestations

Reinfection from inhaled droplet nuclei or reactivated of healed primary ghon complex
A healthy person with latent TB becomes immunocompromised

Cavitation as the focus expands and epithelial damage can occur

RIsk factors: impaired body defence, cell mediated hypersensitivity response damages airway tissue creating cavitation

Manifestations:
Pleuritic pain
Low grade fever
Night sweats
Easy fatigue
Anorexia
Weight loss
Cough (dry to purulent to blood tinged)
Dyspnea
Orthopnea
Complication - pleural effusion

24

Risk factors of lung cancer

Smoking
Chemical toxins
Familial predisposition
Site of metastasis
Disease of the aging over 65yrs

25

Small Lung Cell Cancers

Rare to do surgery after diagnosis
Highly malignant
Tumors arise from the neuroendocine cells of the bronchial epithelium
Grow in clusters and may be able to secrete hormonally active product
Highest associated with smoking

Often metastasized on diagnosis
Paraneoplastic syndrome - SIDAH
Total 2yr survival is 20-40%

26

Non-Small Cell Lung Cancers: Squamous Cell Carcinoma

Central bronchi - diagnosed with sputum culture
Common in men and smokers
Metastasizes slower than others
Paraneoplastic syndrome - hypercalcemia

27

Non-Small Cell Lung Cancers: Adenocarcinoma

Bronchiolar and alveolar
Common in women and non smokers
Pleural fibrosis and scarring
Poorer prognosis than squamous - easy metastasis
Paraneoplastic syndrome - hematologic disorders

28

Non-Small Cell Lung Cancers: Large Cell Carcinoma

Periphery of the lung
Hard to diagnose
Poor prognosis; spreads early

29

Manifestations of Lung Cancer

Cough, wheeze, SOB
Anorexia, weight loss

Hemoptysis
Dull pain increasing with invasion into pleura
Hoarseness - laryngeal nerve involvement
SVC syndrome - tumors compression of superior vena cava interrupting blood flow
Pleural effusion
Metastasis to brain, bone, liver
Paraneoplastic syndromes

30

Paraneoplastic Manifestations of Lung Cancer

Not related to metastasis - caused by substances secreted by the tumor
Weakness and wasting of proximal muscles - pelvic and shoulder girdles
Anorexia
Cachexia
Fever
Hypercalcemia
Hematology disorders - DIC, migratory thrombophlebitis

31

Hypoxemia: causes

Inadequate amount of 02
Disease of the respiratory system
Dysfunction of the neurological system
Alterations in circulatory function

Produces it effects through tissue hypoxia - compensatory mechanisms to adapt

Hypoxia with 99% o2 sat due to severe anemia
Cyanosis without sign and symptoms of hypoxemia due to too much Hgb

32

Hypoxemia: manifestations

Cyanosis
Tachycardia
Vasoconstriction - increase in BP
Personality changes, restlessness, uncoordinated muscle movements, euphoria, impaired judgement, delirium, stupor, coma

Chronic - increased ventilation, pulmonary vessel vasoconstriction, increased production of RBC

33

Hypercapnia: causes

Hypoventilation
Mismatching of ventilation and perfusion
Increase in metabolic rate and high carbohydrate diet
Activity
Fever
Disease

34

Hypercapnia: manifestations

Acid base balance problems
Kidney, NS, and cardiovascular function
Respiratory depression and altered mental status

35

Lung Inflation issues

Compression of lung by fluid accumulation = pleural effusion
Complete or partial collapse due to air in the pleural cavity = pneumothorax
Collapse of a segment of the lung = atalectasis

36

Pleural Effusion: types

abnormal collection of fluid in the pleural cavity
Capillaries filter into parietal space
Interstitial spaces in lungs and peritoneal cavity

Transudate: hydrothorax - CHF, renal failure, nephrosis, liver failure
Exudate: bacterial pneumonia, viral infection, pulmonary infection
Purulent: empyrean - infection of the pleural cavity
Chyle: chylothorax - milky lymph fluid accumulation - trauma, inflammation malignancy
Sanguineous: hemothorax - aneurysm rupture, injury, surgery

37

Pleural Effusion: manifestations

Decreased Lung expansion
Dullness on percussion
Diminished breath sounds
Hypoxemia may occur
Dyspnea
Tachypnea
Pleuritic pain, WBC increase, fever

38

Pneumothorax

Air in the pleural space causing partial or complete lung collapse

SOB
Dyspnea
Hypoxemia

Ipsilateral = affected side

39

Pneumothorax: Spontaneous

Rupture of an air filled bleb on the surface of the lung
Allows atmospheric air to enter the pleural cavity and lung collapses of its own recoil

Primary - healthy person; non smoker
Secondary - underlying lung disease (emphysema, asthma, TB, sarcoidosis, CF)

ipsilateral chest pain
Tachypnea
Dyspnea
Asymmetry of the chest
Hyper-resonant percussion
Decreased or absent breath sounds over area of pneumothorax

40

Pneumothorax: Traumatic

Penetrating or non penetrating chest injury

Fractured or dislocated ribs that penetrate the pleura - hemothorax may accompany
Medical procedures, central line insertion, intubation, CPR complication

41

Pneumothorax: Tension

Intrapleural pressure becomes greater than atmospheric pressure
Air can enter but cannot leave

Complication of mechanical ventilation

Laceration of lung and pressure on SVC - cardiac and respiratory compromise
Pleural space increases in size, mediastinum compression, tracheal shift, pressure on SVC

42

Pleuritis

Pleuritic pain with abrupt onset

Causes
Viral infections
Pneumonia

Pain characteristics
Unilateral
Pain with DB
May be referred to shoulder

43

Musculoskeletal vs bronchial vs myocardial pain

Musc - bilateral, worse with movement and associated with contraction
Bronchi - substernal, dull, worse with coughing, not affected by DB
Myocardial - substernal, not affected by respirations

44

Atelectasis: causes

Incomplete expansion of the alveoli

Causes
Obstruction - anaesthesia, limited mobility, low hydration
Compression - pt lying in bed, pneumothorax, pleural effusion
Increased recoil - loss of surfactant

Primary - lung have never fully expanded
Secondary - aspiration of amniotic fluid
Acquired - obstruction

45

Atelectasis: manifestations

Tachypnea
Dyspnea
Cyanosis
Hypoxemia
Absence of breath sounds
Diminished lung expansion
Intercostal retractions

46

Bronchial Asthma

Chronic inflammatory airway disorder of the pulmonary airways
Not the upper airways

Exaggerated by hypersensitivity response
Seasonal
Exercise induced
Drug induced
Occupational

Bronchoconstriction, increased permeability, increased mucous production

47

Bronchial Asthma: pathophysiology

Exposure to allergen, T helper stimulates B cell to differentiate in to IgE producing plasma cells
IgE pairs up with allergens and binds to mast cells which release histamine
Inflammatory mediators released by activated immune cells

Extrinsic - type one hypersensitivity
Intrinsic - no allergen component

48

Atopic Asthma (extrinsic): result of

Extrinsic allergen or antigen
Genetic predisposition to the development of an immediate hypersensitivity reaction to common antigens

Can be triggered by intrinsic factors
Childhood exposure
Genetics
Other allergies

49

Atopic Asthma (extrinsic): manifestations

Early phase
Chemical mediator release from presensitized IgE mast cells
Histamine, interleukins, prostaglandins = mucosal edema, bronchospasm, wheezing, cough, dyspnea
Parasympathetic response = increased permeability and mucous

Late phase
Inflammation and increased airway responsiveness; mediators continue to be released
Epithelial damage, edema, changes in mucocilliary function, decreased clearance of secretions, increased airway responsiveness

50

Non-atopic Asthma (intrinsic): triggers

Respiratory infection
Exercise
Inhaled irritants
Emotions
Hormones
GI reflux
Aspirin and NSAIDs

51

Asthma Symptoms

Accessory muscles
SOB
Dyspnea
Fatigue
Hypoxemia and hypercapnia
Wheeze
Cough
Chest tightness
Tachypnea
Anxiety
Tachycardia and increased BP
Status asthmatics
Respiratory failure

52

Chronic Obstructive Pulmonary Disease: risk factors

Smoking
Heredity
Occupational dust and chemicals
Airway infections
Asthma and airway hypersensitivity

53

Chronic Obstructive Bronchitis: pathogenesis

Major and small airways
Increased mucous production and chronic productive cough
Inflammation and obstruction of the major and small airways

Risk factors: smoking, men, middle age, recurrent respiratory infection

Hypersecretion in large airways
Hypertrophy of submucosal glands in trachea and bronchi in response to toxins
Inflammation infiltration
Fibrosis of bronchial wall

54

Chronic Obstructive Bronchitis: manifestations

Chronic productive cough
Blue bloater - hypercapnia, hypoxemia, polycythemia and right sided HF leading to fluid retention
Pursed lip breathing
Tripod position

55

Emphysema: pathogenesis

Small airways
Enlargement of airspaces and destruction of lung tissue
Inflammatory response release pro teases that digest elastin and alveolar walls = loss of lung elasticity and enlargement of distal spaces
Slowly debilitating with acute exacerbates

Risk factors: smoking, hereditary deficits in antitrypsin

56

Emphysema: manifestations

Barrel chest
Weight loss
Pink Puffer - lack of cyanosis, use of accessory muscles, pursed lip breathing
Decreased breath sounds
Diaphragmatic fatigue and acute respiratory failure

57

Pulmonary Embolism: causes

Blood borne substance lodges in branch of pulmonary artery
Thrombus injected during IV infusion or DVT or oral contraceptives
Fat mobilized from bone marrow after fracture
Amniotic fluid entering maternal circulation after childbirth

58

Pulmonary Embolism: Pathogenesis

Most arise from a DVT
Reflex is bronchoconstriction in the affected area
Ventilation without perfusion
Impaired gas exchange loss of alveolar surfactant
Pulmonary HTN and rt sided HF may result

59

Pulmonary Embolism: manifestations

Dyspnea
Tachypnea
Pleuritic pain
Cough
Sanguinous sputum
Hypoxemia
Tachycardia
Angina
Anxiety
Fever
Loss of consciousness
Tripod position

60

Cor Pulmonale

Causes rt sided HF secondary to respiratory disease (pulmonary HTN)

Decreased lung ventilation
Pulmonary vasoconstriction
Increased workload on rt heart
Decreased oxygenation
Kidney releases erythropoietin = more RBC = polycythemia = blood more viscous
Increased workload on the heart

Constriction to raise pulmonary vasc
Back pressure from lungs increase heart workload on rt heart from vena cava