Exam 7: P+P Respiratory Tract Infections, Neoplasms, and Childhood Disorders

Rhinosinusitis

Etiology: Follows viral URT infection; caused by bacteria, fungi, or allergens.
Pathophysiology: Inflammation/blockage of paranasal sinuses.
Signs/Symptoms: Facial pain, nasal congestion, purulent discharge, headache, fever.
Diagnosis: Clinical evaluation; sometimes CT or endoscopy.
Cares: Saline irrigation, decongestants, analgesics, antibiotics if bacterial.

Common Cold

Etiology: Rhinoviruses (most common), other viruses.
Pathophysiology: Viral infection of upper respiratory mucosa.
Signs/Symptoms: Nasal congestion, runny nose, sore throat, cough, sneezing, fever.
Diagnosis: Based on clinical symptoms.
Cares: Rest, fluids, OTC symptom relief.

Influenza

Etiology: Influenza viruses A, B, C.
Pathophysiology: Viral infection causing inflammation and cell death in respiratory epithelium.
Signs/Symptoms: High fever, chills, headache, muscle aches, cough, fatigue.
Diagnosis: Clinical evaluation, rapid tests, or viral cultures.
Cares: Rest, fluids, antipyretics, antivirals (e.g., oseltamivir).

Pneumonia

Etiology: Bacteria, viruses, fungi, or aspiration.
Pathophysiology: Inflammation of lung parenchyma with alveolar fluid accumulation.
Signs/Symptoms: Cough, fever, chills, SOB, chest pain, sputum.
Diagnosis: Clinical evaluation, chest X-ray, sputum culture.
Cares: Antibiotics (bacterial), antivirals (viral), oxygen therapy, supportive care.

Tuberculosis (TB)

Etiology: Mycobacterium tuberculosis.
Pathophysiology: Lung infection causing granulomas, chronic inflammation.
Signs/Symptoms: Chronic cough, fever, night sweats, weight loss, hemoptysis.
Diagnosis: Skin test (TST), IGRA, chest X-ray, sputum cultures.
Cares: Long-term antibiotics.

Lung Cancer

Etiology: Smoking, radon, asbestos, pollution, family history.
Pathophysiology: Abnormal cell growth in lungs.
Signs/Symptoms: Persistent cough, hemoptysis, SOB, weight loss, fatigue.
Diagnosis: X-ray, CT scan, biopsy.
Cares: Surgery, radiation, chemotherapy, targeted/immunotherapy.

Respiratory Distress Syndrome (RDS)

Etiology: Prematurity, surfactant deficiency.
Pathophysiology: Increased alveolar surface tension causes collapse and impaired gas exchange.
Signs/Symptoms: Tachypnea, nasal flaring, cyanosis, grunting.
Diagnosis: Clinical evaluation, chest X-ray.
Cares: Surfactant replacement, oxygen, mechanical ventilation.

Croup

Etiology: Viral infection (e.g., parainfluenza).
Pathophysiology: Inflammation of larynx, trachea, bronchi.
Signs/Symptoms: Barking cough, stridor, hoarseness, SOB.
Diagnosis: Clinical evaluation.
Cares: Humidified air, corticosteroids.

Epiglottitis

Etiology: Haemophilus influenzae type b (Hib).
Pathophysiology: Inflammation/swelling of epiglottis, obstructing airway.
Signs/Symptoms: High fever, sore throat, drooling, stridor, respiratory distress.
Diagnosis: Clinical evaluation, lateral neck X-ray.
Cares: Emergency intubation, antibiotics.

Q: What is the difference between small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC)?

A: SCLC has small, round cells with scant cytoplasm and is aggressive, with chemotherapy and radiation being the primary treatment. NSCLC has larger cells with abundant cytoplasm and can be treated with surgery, radiation, chemotherapy, immunotherapy, and targeted therapy.

Q: What are three paraneoplastic manifestations of lung cancer?

A: Superior vena cava syndrome, pleural effusions, and hyperuricemia.

Q: When is surfactant produced in neonates?

A: Surfactant production begins around 24–28 weeks of gestation and matures by 34–36 weeks.

Q: What are the consequences of low levels of surfactant in neonates?

A: Premature infants may experience respiratory distress syndrome (RDS) due to alveolar collapse and impaired oxygen uptake.

Q: What are the causes and manifestations of respiratory distress syndrome (RDS)?

A: RDS is caused by a lack of surfactant in premature infants, leading to increased surface tension in the alveoli, causing rapid breathing, nasal flaring, grunting, and cyanosis.

Q: What are the causes and manifestations of bronchopulmonary dysplasia (BPD)?

A: BPD is caused by prolonged mechanical ventilation and oxygen therapy for RDS, leading to wheezing, crackles, chronic lung changes, and respiratory distress.

Q: What are the signs of impending respiratory failure in small children?

A: Rapid breathing, increased work of breathing (nasal flaring, retractions), altered skin color (cyanosis, pallor), altered mental status, abnormal breath sounds, and decreased oxygen saturation.

Q: Why are older adults at greater risk for acute respiratory failure?

A: Aging reduces lung elasticity, weakens respiratory muscles, decreases the cough reflex, and reduces respiratory reserve. Chronic conditions like COPD and heart failure also increase risk.

Q: How does community-acquired pneumonia differ from hospital-acquired pneumonia?

A: CAP is caused by pathogens like Streptococcus pneumoniae and has a generally good prognosis. HAP, often caused by multidrug-resistant organisms, is more severe and has a higher risk of complications.

Q: How does pneumonia in immunocompromised individuals differ?

A: It can be caused by opportunistic pathogens like Pneumocystis jirovecii, with symptoms often being subtle, and the prognosis is poorer due to the increased risk of complications.

Q: What are the immunologic properties of Mycobacterium tuberculosis?

A: It causes an immune response that leads to granuloma formation (Ghon complexes). If the immune system weakens, the bacteria can reactivate, causing tissue destruction.

Q: What is the difference between primary tuberculosis and reactivated tuberculosis?

A: Primary TB is often asymptomatic or presents with mild flu-like symptoms. Reactivated TB presents with persistent cough, weight loss, and chest pain.