What are the primary symptoms of respiratory disease?
Cough, fever, dyspnea, sputum
When used for diagnosing, what does sputum signal?
Denotes airway disease unless lung abcess. Also seen in asthma, bronchitis, or bronchiectasis
What information is needed to solve the problem of diagnosis?
Exacerbation of existing disease
Slow progressing disease
What are possible upper respiratory tract infections?
What are the signs and symptoms of rhinitis?
Nasal turbinates, erythema, swelling, exudate
What is the etiology of rhinitis?
Viral, bacterial, antigenic, hormonal (premarin/progesterone)
What is the etiology of sinusitis?
Viral, bacterial, antigenic, immunogenic, hyperplasia
What are the signs and symptoms of sinusitis?
Nasal turbinates, erythema, swelling, yellow to green educate, pain in sinuses with palladium, sinus swelling
What is the treatment of rhinitis?
Antihistamines, topical steroids, leukotriene receptor antagonist, expectorants
What is the treatment of sinusitis?
Antihistamines, anti-inflammatories, antibiotics, expectorants
What is the etiology of laryngitis?
Viral, bacterial, inflammation, infection, hyperplasia, dysplasia
How is laryngitis diagnosed?
Auditory hoarseness, laryngoscopy, ct imaging
How is laryngitis treated?
Supportive, ENT specialist care, rest larynx no talking
What is the etiology of pharyngitis?
Post nasal drainage(vesicles/cobblestone appearance), viral, bacterial (group a beta hemolytic strep or other pathogens)
What are the signs and symptoms of pharyngitis?
Erythema, mid to posterior pharyngeal abcess swelling, pain, exudate in tonsils and posterior pharynx
What is the treatment for pharyngitis?
Bacterial source- microbial
Viral or post nasal drainage- supportive and treatment of sinusitis(antihistamines, anti-inflammatory, expectorants)
What are the possible lower respiratory tract diseases?
Infections- pneumonia, lung abcess, tuberculosis
What is the purpose of the pulmonary circuit in circulation?
Facilitate gas exchange
Reservoir for left ventricle
What is the difference I. Pressure between the pulmonary circuit and systemic circuit?
The pulmonary circuit has less pressure and resistance
What are possible responses to irritants in the airways?
Cough, bronchoconstriction, increased ventilatory rate
What does the Hering-Breuer expiratory reflex control?
Decreases ventilatory rate and volume
What occurs when the j-receptors(juxtapulomnary capillary receptors) are initiated?
Sensitive to increased pulmonary capillary pressure
Initiates rapid, shallow breathing
What should be monitored with initiation of the j receptors?
What are the different types of pneumonthorax?
Open, tension, spontaneous, secondary
What occurs in an open pneumonthorax ?
Communication with atmospheric pressure
What occurs in a tension pneumothorax?
Site acts as a one way valve and air enters but cannot escape?
What occurs in a spontaneous pneumothorax ?
Rupture of blend on visceral pleura, usually
What occurs in a secondary pneumothorax?
Chest trauma, disease, mechanical ventilation
What are the signs and symptoms of a pneumothorax?
Possible compression atelectasis
Possible displacement of medistinal contents
How is a pneumothorax diagnosed?
Chest X-ray for air in apex of lung
What is the treatment of a pneumothorax?
Remove air/blood from parietal/visceral space
Re-expand lung with chest tubes
What are the possible etiologies of a pulmonary emboli?
What is the manifestation of a pulmonary emboli?
Ischemia of all tissue distal to supporting vasculature
What are the signs and symptoms of a pulmonary emboli?
patient can be asymptomatic, SOB, chest pain, tachypnes, V/Q Imbalances, low PaCO2, low PaO2, pulmonary hypertension, decreased cardiac output, systemic hypotension, shock
How is pulmonary emboli diagnosed?
pulse ox, chest x-ray, VQ Scan showing ventilation but no perfusion, CT scan, D-Dimer, MRI
What is the treatment for pulmonary emboli?
prevention, supportive O2, anticoagulants
What is atelectasis?
Inadequate aveolar filling where air is replaced by fluid
What is flail chest?
hole in pleural space
What is pleural effusion?
fluid in pleural space which can lead to ateclectasis or displaced mediastinal contents
What is Pleurisy?
inflammation between parietal and visceral pleura
What is Costochondritis?
Inflammation between ribs in intercostal spaces
Is the most common cause of chest pain in children
What is an Empyema?
Infection in pleural space
What is pneumoconiosis?
Inhalation of inorganic dust particles
How does pneumoconiosis manifest?
What is the etiology of pneumononiosis?
idiopathic, result of inflammatory process after exposure to antigen/immunogen
What is the symptom of pneumoniosis?
decreased lung compliance
What is the etiology of Adult Respiratory Distress Syndrome?
What are the manifestations of ARDS?
Inflammation, diffuse aveolo-capillary injury leading to increased capillary permeability causing pulmonary edema, hyaline membrane form, fibrosis, decreased FRC
What is the etiology of Asthma?
Hyper-responsivity to co-morbid allergies
What symptoms classify Mild Intermittent Asthma?
Symptoms 2/wk or 2/night/month Peak flows greater than or equal to 80% of your personal best, with less than 20% variability in daily peak flow measurements
What symptoms classify mild persistent asthma?
more than 2/wk but less than 1/day or 2/night/month
What symptoms classify moderate persistent asthma?
daily symptoms or more than 1/night/wk
Peak flows that are 60 to 80% of personal best, or more than 30% variability in daily peak flow measurements
What symptoms classify severe persistent asthma?
Continual symptoms with peak flows that are less than or equal to 60% of personal best, or more than 30% variability in daily peak flow measurements
What are the medications used to treat asthma?
Mucolytics, Antihistamines, Bronchodialators, antiinflammatories, leukotriene receptor antagonist
What are the goals of treatment for asthma?
minimal or no chronic symptoms
minimal or no exacerbations
no limitations on activities
peak flows greater than 80% of personal best
minimal or no adverse effects from medications
What is COPD?
Chronic, irreversible pathologic lung changes
What is primary emphysema?
Deficiency of alpha 1 antitrypsin which inhibits the action of prteolytic enzymes
What is secondary emphysema?
Deficiency of alpha 1 antitrypsin by smoking because of excessive neutrophils in the lungs
Parenchyma releases prtolytic enzymes that damage respiratory bronchioles and alveolar walls
What occurs in emphysema?
destruction of aveolar septa
elimination of portions of capillary bed
Increases volume of air in acinus
Loss of elastic recoil causes expiratory difficulty
Hyperinflation of aveoli
What are the clinical manifestations of Emphysema?
exertional dyspnea progressing to resting dyspnea
no cough in beginning
little sputum production
tachypnea with prolonged expiration
use of accessory muscles
AP diameter increased
Hyper-resonance with percussion
How is emphysema diagnosed?
Chest X-Ray showing flat diaphragm, transulucent and overdistended lung fields
PFT's- decreased FVC FEVI, increased FRC, RV, and TLC
What is the treatment for emphysema?
Removal of irritant
WHat is the disease progression of emphysema?
usually accompanied with chronic bronchitis
Increased number of infections
What is the etiology of pneumonia?
What are the manifestations of pneumonia?
inflammatory and immune response result in deposits of fibrin on pleural surfaces, consolidation of lung parenchyma
70% of all cases of pneumonia are
What is hospital acquired pneumonia likely to cause?
residual lung sequellae like lung abcess or emphyema
What are the likely causes of exposure to the organisms causign pneumonia?
inspiration of infected droplets
Porr dental hygeine causes normal flora to become pathogenic
IV drug abuse
How is pneumonia diagnosed?
Chest Xray shows infiltrates
Color of sputum (rusty streptococcus, salmon pinkl staphylococcus, green pseudomonial)
Amount of sputum (Myoplasma and viral have scant sputum)
Culture and sensitivity of sputum
What are the clinical manifestations of pneumonia?
productive or dry cough
What is the treatment for pneumonia?
What isthe criteria for hospitalization for pneumonia?
Any 3 of:
resp rate >30
uremia, BUN >20
Leukopenia, WBC <20,000
PaO2/FiO2 ratio <250
Thrombocytopenia, plt <100,000
Hypotension requiring agressive fluid rescucitation
What is the etiology of Tuberculosis?
How is Tuberculosis transmitted?
Aireborn droplet or tissue contamination
What is the patho of tuberculosis?
inflammatory response engulfs bacilli in granuloma or tubercle which causes a decreased function on lung parenchyma
Phagocytosis breaks down granuloma releasing new bacilli
What are the clinical manifestations of tuberculosis?
erosion of tubercle into parenchyma and possibly vessels
How is tuberculosis diagnosed?
skin test (BCG immunization can cause false positive)
What is the treatment for tuberculosis?
Protect immune compromised
What is the etiology of ung cancer?
What are the different types of lung cancer?
What are the clinical manifestations of lung cancer?
How is lung cancer diagnosed?
What is the usual treatment for lung cancer?