Patho- Module 3: Respiratory (EXAM 2)

infectious rhinitis (aka the common cold)

-upper respiratory infection

-highly contagious (caused by the rhino virus)

-the very young, very old, and immunocompromised are at risk

-incubation of 2-3 days (if longer we are highly concerned)

-inspiratory vs expiratory

what are the manifestations of infectious rhinitis?

-sneezing

-nasal congestion/nasal discharge

-sore throat

nonproductive cough

-malaise

-myalgia

-low-grade fever,

-hoarseness, headache, and chills

What is rhinosinusitis?

-upper respiratory infection

-inflammation of the sinus cavities

-causes: viruses, bacteria, and fungi

-exudate collects and blocks sinus cavities

-acute: 4 weeks or chronic: more than 12 weeks with constant pain and leaking

what are the manifestations of rhinosinustitis?

-facial pain

-nasal congestion lots of mucous

-fever

-sore throat

what is epiglottitis?

-upper respiratory infection

-it is an inflammation of the epiglottis (the lid that covers our tracheal opening aka we need it to breathe)

-it is a medical emergency!!

-these patients are extremely sick and low energy

what are the causes of epiglottitis?

-haemophilus influenzae type B

(Hib) (common infection in children)

-throat trauma

what are the manifestations of epiglottitis?

-drooling (cannot tolerate oral secretions aka cant swallow)

-odd sitting forward position (trunk leaning forward)

-inspiratory stridor

-respiratory distress

-central cyanosis

-pallor

What is laryngitis?

-upper respiratory infection

-inflammation of the larynx

-self limiting (meaning that it gets better on its own)

-worst case scenario is that the larynx swells so much that breathing stops

what are the causes of laryngitis?

-infection

-increased upper respiratory exudate

-overuse

what are the manifestations of laryngitis?

-hoarseness

-weak voice or voice loss

-tickling sensation

-raw feeling in the throat (no mucous)

-sore throat

-dry cough and difficulty breathing

what is laryngotracheobronchitis? (aka croup)

-common viral infection in children usually parainfluenza viruses and adenoviruses

-larynx and surrounding area swell, leading to airway narrowing, obstruction, and respiratory failure

what are the manifestations of laryngotracheobronchitis? (aka croup)

-seal like barking cough

-congestion

-hoarseness

-inspiratory stridor

-dyspnea

-anxiety

-central cyanosis

what is influenza? *(aka the flu)

-viral infection that may affect the upper and lower respiratory tract

-a highly adaptive and intelligent virus

-incubation time of 1-4 days

-children, elderly, and immunocompromised are at risk!

what are the different types of influenza?

type a: most severe and most common in the united states

type b: less severe

type c: usually causes small outbreaks (seen more in animals)

what are the manifestations of influenza?

-fever

-headache

-chills

-dry cough

-body aches

-nasal congestion

-sore throat

-sweating

-malaise (you feel too sick to do anything else)

how can we prevent influenza?

-hand washing

-isolation and avoiding crowds

-annual vaccination

what is acute bronchitis?

-lower respiratory infection

-inflammation of the tracheobronchial tree or large bronchi

what causes acute bronchitis?

-viruses

-bacteria

-irritant inhalation

-allergic reactions

what are the manifestations of acute bronchitis?

-productive and nonproductive cough

-dyspnea

-wheezing

-low grade fever

-pharyngitis

-malaise

-chest discomfort!

how do we diagnose acute bronchitis?

-history

-physical examination

-X-ray

what is bronchiolitis?

-lower respiratory infection (can go from upper to lower)

-common acute inflammation of the bronchioles, usually respiratory syncytial virus

-more frequent in children younger than 1 year and during the winter months

-can lead to atelectasis (partial or complete collapse of lung/lobe) AND respiratory failure

what are the manifestations of bronchiolitis?

-chest retractions!!

-nasal drainage

-nasal congestion

-cough

-wheezing

-rapid and shallow breathing

-dyspnea

-tachycardia

-malaise

what is pneumonia?

-inflammation of the lungs and produces EXCESS fluid and causes an infection

-damage to the bronchial mucous membranes and alveolocapillary membranes

-infectious debris and exudate

-some microbes will release toxins from cell walls which will further lung damage

-top ten leading causes of death in the US

what is the most common route for lower tract infections and the most common cause for pneumonia?*

aspiration of oropharyngeal secretions!

what is primary pneumonia

when the agent is inhaled and causes pneumonia

what is secondary pnemonia?

-a complication from another disease

what populations are more susceptible to and the risks of pneumonia?

-children

-older people

-immunocompromised patients

what are some ways to acquire pneumonia?

-through inhalation of microorganisms that are released in the air (infected individual coughs, sneezes, talks)

-contaminated respiratory therapy equipment such as endotracheal tubes

what causes pneumonia?

-pneumococcus (Streptococcus pneumoniae) is the most common and lethal cause of outpatient and inpatient pneumonias

-infectious agents

-pulmonary secretion stasis

what are the manifestations of pneumonia?

-productive cough (sometimes nonproductive cough)

-fatigue

-crackles or rales in the lower basis

-tachypnea

-dyspnea

-fever

-chills

-pleuritic pain

-mental status change especially in the elderly

what is the most common cause of CAP (community acquired pneumonia)?

-influenza

how do we prevent pneumonia?

-turn, cough, deep breath (TCDB!)

-hand washing

-vaccinations

-smoking cessation

what is tuberculosis?

-infectious disease caused by bacillus mycobacterium tuberculosis

-airborne! only need one single micro droplet to contract it

-occurs mainly in lungs but can spread to other organs

what is latent tuberculosis?

-someone who is infected but do not have an active infection

-occurs during reactivation of dormant bacilli

*ONLY people with active tb can spread the infection to others

what are red flags for tuberculosis?

-hemoptysis

-night sweats

-fever

-chills

-fatigue

-unexplained weight loss

-anorexia

what are ways to prevent tuberculosis?

-vaccination

-respiratory precautions

-adequate ventilation

-appropriate isolation

what is asthma?

-REVERSIBLE but not curable!

-acute airway inflammation with broncho constriction, spasms, edema, and mucous production

-often the result to a strong immune reaction to an antigen but we do not really know

-chronic with periods of symptoms

which asthma is more common in children?

-intrinsic asthma

-usually triggered by allergens such as food, pollen, dust, and medications

what is asthma is more common in adulthood?

-extrinsic asthma

-more common in women

-non allergic reaction

-can be triggered by upper respiratory infections, air pollution, emotional stress, smoking, exercise, and cold exposure

what is nocturnal asthma?

-usually occurs between 3:00 and 7:00 a.m.

-may be related to circadian rhythms - at night, cortisol and epinephrine levels decrease, while histamine levels increase, leading to bronchoconstriction

what is exercise-induced asthma?

a medical condition characterized by shortness of breath induced by sustained aerobic exercise

what is occupational asthma?

-like other types of asthma, it is characterized by airway inflammation, reversible airways obstruction, and bronchospasm, but it is caused by something in the workplace environment

what is drug-induced asthma?

-frequently caused by aspirin

-can be fatal

-reactions can be delayed up to 12 hours after drug ingestion

what is chronic obstructive pulmonary disease?

-COPD

-an umbrella term used to describe a group of respiratory disorders

-the two disorders are chronic bronchitis and emphysema!

-characterized by irreversible, progressive and causes tissue degeneration

-airway obstruction

-AKA structural changes in the lung

-often asymptomatic and masked by smoking

where is COPD found?

-lungs

-pulmonary circulation

*severe hypoxia and hypercapnia can lead to respiratory failure

what is the single most contributing factor to COPD?

-long term smoking!

what is cor pulmonale?

-right sided heart failure caused by high blood pressure

-caused by respiratory disorders especially COPD

what is chronic bronchitis?

-inflammation of the bronchi, a productive cough, and excessive mucous production

-airway obstruction from excessive mucous and inflammation!

-not caused by an infection but by the nature of what is happening in their airways these patients will develop many infections

*think blue boater!

what are the complications of chronic bronchitis?

-frequent respiratory infections and

-respiratory failure

what are the manifestations of chronic bronchitis?

-dyspnea at rest

-hypoventilation

-hypoxemia

-cyanosis (clubbing fingers)!

-peripheral edema

-weight gain

-rhonchi and wheezing

-chest pain (more like wall pain)

-fever

what is emphysema?

-destruction of the alveolar walls leads to large, permanently inflated alveoli

-loss of elastic recoil and hyperinflation of the alveoli which leads to air trapping

what causes emphysema?

-genetic predisposition

-smoking!

what are the manifestations of emphysema?

-dyspnea upon exertion (when the person is physically active)

-think pink puffer!

-barrel chest

-increased anterior-posterior

-thoracic diameter (from 1:2 to 1:1) AKA barrel chest!

-activity intolerance

-anorexia

-malaise

what is cystic fibrosis? (3 questions)

-an inherited/genetic life threatening of the mucous and sweat glands

-primarily affects the lungs and the pancreas but truly any duct that produces some kind of liquid

-affects cells that produce mucous, sweat, saliva, and digestive secretions. the secretions will become thick and sticky!

-a terminal disease! this will kill you!

-this is an autosomal recessive mutation that leads to an abnormality in the protein involved in chloride cellular transport

what are manifestations of cystic fibrosis?

-salty skin

-meconium ileus

-steatorrhea (greasy stool)

-delayed growth and development

-cor pulmonal

-chronic cough

-hypoxia (eventually leading to respiratory failure leading to death)

-audible rhonci

what is lung cancer?

-may occur as a primary or secondary tumor

-second most common cancer

-the risk of developing lung cancer is directly related to the amount someone has smoked a day and how many packs per year

what is small cell carcinoma lung cancer?

-almost exclusively in smokers

-extremely fast onset and progression

-deadly

-metastasizes very fast!

-less frequent

what is non-small cell carcinoma lung cancer?

-most common type of malignant lung cancer

-very aggressive

-has several sub-groups

what are the complications of lung cancer?

-airway obstruction

-lung tissue inflammation

-fluid accumulation

-paraneoplastic syndrome

what are the manifestations of lung cancer?

-cough

-hemoptysis

-persistent cough or change in cough

-shortness of breath

-weight loss/anemia

-frequent respiratory infections

-dyspnea

what is pleural effusion?

-excess fluid (blood or pus) in the pleural cavity which can impair breathing

-may also see pleurisy which is inflammation of the pleural membranes

-this can compress the lungs!

-caused by an alteration in ventilation

what are the manifestations of pleural effusion?

-absent lung sounds on the affected side

-tachycardia

-pleural friction rub you will hear on auscultation (when fluid rubs together aka abnormal lung sounds)

-dyspnea

-chest pain

what is ventilation pneumothorax?

-air in the pleural cavity which can cause lung to collapse

what is spontaneous pneumothorax?

where air enters from an opening in the internal airways

1. Primary spontaneous pneumothorax: usually mild

-occurs when a small air blister (bleb) on the top of the lung ruptures

- blebs are caused by a weakness in the lung tissue

-occurs in people with no hx of lung disease. they are usually tall, thin men

2. Secondary spontaneous pneumothorax:

-more severe and even life-threatening

-develops in people with preexisting lung disease

-weakened lung tissue ruptures

what is traumatic pneumothorax?

-caused by blunt (i..e rib fracture) or penetrating (i.e. gunshot) trauma

what is tension pneumothorax?

-the most serious type! big emergency!

-can cause the affected lung to collapse!

-due to trapped air in the pleural space or air from a positive-pressure mechanical ventilator

-ultimately can put pressure on the heart and cause it to stop beating!

what are the manifestations of pneumothorax?

-sudden chest pain

-drop in blood pressure (hypotension) and oxygen and rise in the hear rate (tachycardia)

-chest tightness,

-dyspnea and tachypnea

-decreased breath sounds over the affected area

-asymmetrical chest movement

-trachea and mediastinum deviation

anxiety

-pallor

what is a pulmonary embolism?

-usually caused by a thrombus from the lower legs that moves up to the lungs (blood clot is most common)

-can also be caused fat (from bone marrow especially following femur fracture) or air or a foreign body

what can a pulmonary embolism result in?

-embolus with infarction (death of lung tissue)

-embolus without infarction (does not cause permanent lung injury)

-massive occlusion (occludes a major part of the pulmonary circulation)

*can vary in severity based on size and location

what is atelectasis?

-collapse of the alveoli in the lung

prevents normal exchange of O2 and co2

-hypoventilation occurs

-caused by too much surfactant (watery and soapy substance that prevents the alveoli from collapsing) deficiencies

what are the manifestations of atelectasis?

-restlessness

-diminished breath sounds

-dyspnea

-tachypnea

-asymmetrical lung sounds

-shallow breathing

-coughing

-wheezing

what is acute respiratory failure (ARF)?

-life threatening inability of the lungs to maintain adequate oxygenation

-the result of many respiratory conditions

-can lead to heart failure and death

what body systems are affected by covid?

-thrombi (thrombus aka blood clot)

-the heart

-acute coronary syndromes

what is viral pneumonia?

-caused by a virus

-usually mild

-can lead to secondary bacterial pneumonia

-a nonproductive cough with a low grade fever

what is bacterial pneumonia?

-more common than viral pneumonia

-more often due to the bacteria causing pneumonia

-a productive cough with a higher fever than viral pneumonia

what is aspiration pneumonia?

-occurs when aspirated fluids enter the lungs

what causes aspiration pneumonia?

-impaired gag reflex

-improper lower esophageal sphincter closure

-inappropriate gastric tube placement

what is lobar pneumonia?

-confined to a single lobe

-all based on the affected lobe

what is bronchopneumonia?

-most frequent type

-a patchy pneumonia across several lobes

what is interstitial (atypical) pneumonia?

-occurs in the area between the alveoli

-routinely caused by viruses or by uncommon bacteria

-more rare

what is nosocomial pneumonia?

-hospital acquired pneumonia

-develops more than 48 hours post hospital admission

what is CAP?

-community acquired pneumonia

-acquired outside the hospital or healthcare setting

what is ventilator associated pneumonia?

-occurs in patients that have been on mechanical ventilation for more than 48 hours

what are the manifestations of tuberculosis?

- productive cough

- hemoptysis (coughing up blood/bloody secretions)

- night sweats

- fever

- chills

- fatigue

- unexplained weight loss

- anorexia

what are the different stages in an asthma attack?

stage one: peaks within 15 to 30 minutes. usually signaled by coughing and inflammatory response

stage two: peaks within hour 6 of symptom onset. a result of airway edema and mucous production causing air to trap (think narrow airways!)

what is status asthmaticus?

-an often-fatal, prolonged asthma attack unresponsive to usual treatment

-can quickly lead to respiratory alkalosis

and respiratory failure

what are the symptoms of status asthmaticus?

-rapid breathing

-extreme wheezing

-shortness of breath

-chest tightness

-chronic cough

-racing heartbeat