Physiology Ii : (Test I) : Respiratory Infections : Chapter 30

Front 1

List 7 respiratory infections.

Back 1

1. Common cold

2. Sinusitis

3. Influenza

4. Pneumonias

5. Tuberculosis

6. Fungal Infections

7. SARS

Front 2

List the conducting airways?

Back 2

1. Nasal passages

2. mouth

3. pharynx

4. larynx

5. trachea

6. bronchi

7. bronchioles

8. protective anatomy = cilia, mucociliary blanket, glottis/laryngeal muscles (can close up)

Front 3

What is a lobule?

Back 3

The smallest functional unit of the lung.

Terminal respiratory bronchioles, alveolar sacs, alveolar ducts.

Protective anatomy = lymphatic system, macrophages.

Front 4

What is the pleura?

Back 4

Lines the thoracic cavity and encases lungs.

Serous fluid separates pleural layers.

Potential are for inflammation. (Pleural effusion)

Front 5

What is the common cold essentially?

Back 5

VIRAL infection of UPPER respiratory tract (not the lower/alveoli)

Front 6

What are the modes of transmission for the common cold?

Back 6

1. Person to Person

2. Virus also exist on fomites (inanimate objects)

Front 7

How is the common cold spread from person to person?

Back 7

Shed primarily from nasal mucosa.

Shed at incubation period and start of sx.

Front 8

How is the common cold spread from fomites?

Back 8

Virus exists on fomites.

Contact from fomite to hands and fingers.

Hands/fingers then may have contact with eyes and nasal mucosa.

Front 9

How long can the cold virus survive on a fomite?

Back 9

5 or more hours.

Front 10

What is a bigger factor in the spread of the common colds; fomite contact or sneezing?

Back 10

Fomites

Front 11

How many viruses are responsible for the common cold? Why is this relevant?

Back 11

Over 200 viruses responsible. This is why despite immunity we get them again and again.

Front 12

Do people usually display a fever when they have a common cold?

Back 12

No, they typically have no fever. Fever is associated more with a flu or very severe cold.

Front 13

What is the incubation period for the common cold?

Back 13

2-5 days

Front 14

When is someone with a common cold the most contagious? By when are they not contagious at all?

Back 14

Most contagious in the first 2-3 days.

Not contagious at all by days 7-10.

Front 15

The S&S of the common cold develop over ? days and last up to ? days.

Back 15

The S&S of the common cold develop over 2-3 days and last up to 10 days.

Front 16

The common cold is self limiting. What does this mean?

Back 16

It alleviates on it's own.

Front 17

Common cold infection tends to be what? List 3 examples.

Back 17

Seasonal

1. Rhinovirus (this is the key player for people between the age of 5-40yo)

2. Respiratory Syncytial Virus (RSV)

3. Parainfluenza virus

Front 18

When is the rhinovirus infection typically seen?

Back 18

In the early fall or late spring.

Front 19

How many types of rhinovirus exist?

Back 19

Over 100

Front 20

What two viruses associated with the common cold are typically seen more in children?

Back 20

Respiratory Syncytial Virus
(RSV)

Parainfluenza Virus

Front 21

When is the RSV infection typically observed?

Back 21

Winter and Spring.

Front 22

When is the parainfluenza virus typically seen?

Back 22

Fall and late spring.

Front 23

What is the diagnosis and tx for the common cold?

Back 23

Based upon S&S (can only really tx sx)

OTC cold remedies

Fluids

NOT antibiotics

Chicken Soup (Vapors, fluids)

Front 24

What is the best way to prevent the common cold?

Back 24

Hand washing

Front 25

Normally the sinuses are a ? environment.

Back 25

Sterile

Front 26

What is sinusitis?

Back 26

Inflammation of paranasal sinuses.

Front 27

What essentially are sinuses? List the paranasal sinuses.

Back 27

Essentially air pockets located in the bones of the skull.

1. Frontal
2. Ethmoid
3. Sphenoid
4. Maxillary

Front 28

How many people are effected by sinusitis in the U.S. each year?

Back 28

30 million adults and children in the U.S. each year.

Front 29

Sinusitis may be in what 3 categories?

Back 29

Inflammation results in blocked sinuses and infection.
May be:

1. Acute

2. Subacute

3. Chronic

Front 30

How long does acute sinusitis last?

Back 30

2-3 weeks

Front 31

How long does subacute sinusitis last?

Back 31

Lasting 3 weeks to 3 months.

Front 32

What does subacute sinusitis cause?

Back 32

Reversible changes to epithelium.

Front 33

How long does chronic sinusitis last?

Back 33

Lasting >3 months.

Front 34

What does chronic sinusitis cause?

Back 34

Irreversible change of mucosa.

Front 35

Infections in people with sinusitis is caused by what?

Back 35

Infection from:

1. Bacteria

2. Viruses

3. Fungi

Front 36

Normally what does the sinus mucosa do? What happens when there is an obstruction?

Back 36

Sinus mucosa cilia moves mucous and debris into nasal cavity.

Obstruction of sinuses due to inflammation impairs mucous mvmt and leads to infection.

Front 37

What facilitates microbe growth in the sinuses?

Back 37

Low O2 content.

Front 38

What are the causes of sinusitis?

Back 38

Anything that causes obstruction: like polyps, NG tubes, Asthma, and foriegn bodies.

Anything that impairs ciliary functions: like smoking, GERD, Air pollution, bulimia, cystic fibrosis, excess mucosa

Anything that results in xs mucous production: like bronchitis, rhinitis, cold, upper respiratory tract infection

Weakened immune system: from HIV, chemotherapy, etc.

Front 39

What are the ACUTE S&S of sinusitis?

Back 39

1. Common cold-like

2. Facial pain, pressure

3. Purulent nasal discharge; decreased smell

Front 40

What are the CHRONIC S&S of sinusitis?

Back 40

1. Postnasal drip

2. Loss of smell, bad breath (from organisms)

3. Headache

Front 41

What are some complications associated with sinusitis?

Back 41

Intracranial abscesses, meningitis, orbital movement

(these are esp. associated with chronic sinusitis)

Front 42

How is sinusitis diagnosed?

Back 42

Symptom history and physical exam (including nose and throat)

Nasal endoscopy: indicated in persons who don't respond to therapy as expected.

Front 43

List 4 txs for sinusitis.

Back 43

1. Anti-microbial

2. Decongestants (help drain)

3. Corticosteroids to reduce inflammation

4. Surgery to correct obstruction, if any.

Front 44

Essentially what is the flu?

Back 44

VIRAL infection of UPPER and LOWER respiratory tract.

(remember a cold is just the upper)

Front 45

Rates of flu infection are highest in who?

Back 45

Highest in children.

Front 46

What happens about every 30 yrs with influenza?

Back 46

We see pandemic flus -> around the globe -> tons infected, tons die...many pandemics first seen in SE asia.

Front 47

What virus family isa assoc with the flu?

Back 47

Orthomyxoviridae family (SS RNA virus)

Front 48

What are the 3 broad types of virus?

Back 48

Types A, B, and C.

Front 49

What types of flu virus cause epidemics?

Back 49

Only A and B cause epidemics.

C causes mild respiratory illness...not epidemics

Front 50

How is type A flu classified?

Back 50

By surface Ags (proteins).

H = hemagglutin

N = neuraminidase

Each has antigen subtypes (15 for H, 9 for N)

Front 51

What is antigenic DRIFT?

Back 51

H and N surface Ags vary SLIGHTLY yearly, causing new infection. So you can get infected every year. This is just part of the way that the virus replicates itself.

Front 52

What is antigenic SHIFT?

Back 52

ABRUPT, MAJOR change in H and/or N Ag, resulting in new protein that is completely unrecognized by immune system.

This causes a PANDEMIC.

Front 53

Antigenic shift and drift occur more with type ?.

Back 53

With type A

Front 54

Generally what 3 strains cause flu yearly?

Back 54

Two type A and one B.

Vaccine determined by worldwide surveillance to determine likely strains causing disease.

Front 55

What are some of the risk factors for the flu?

Back 55

1. Elderly : > 65 yo

2. Chronic illness (COPD, CHF, diabetes mellitus, renal failure)

3. Immunosuppression (HIV, CA, transplant)

4. Close contact (nursing homes, health care workers)

Front 56

What is the incubation period for the flu?

Back 56

1-4 days.

Front 57

When is a person with the flu infectious?

Back 57

Infectious 1 day before sx onset (so don't even know yet), remain infectious for ~5 days after onset.

Front 58

What are the sx in the early stages of the flu?

Back 58

ABRUPT ONSET of FEVER (unlike cold) and chills, malaise, muscle aches, headache, profuse watery discharge, nonproductive cough, sore throat.

Front 59

What are the 3 types of infection associated with the flu?

Back 59

1. Uncomplicated rhinotracheitis

2. Viral pneumonia

3. Respiratory viral infection complicated by bacterial infection

Front 60

What is uncomplicated rhinotracheitis?

Back 60

This is what most people assoc with the flu.

Upper resp. tract infection and inflammation.

Necrosis and shedding of ciliated and serous mucous cells.

Front 61

What are the sx of uncomplicated rhinotracheitis?

Back 61

Abrupt fever, chills, body aches, watery discharge, sore throat, dry cough.

Front 62

When does uncomplicated rhinotracheitis peak? When does it resolve?

Back 62

In 3-5 days...resolves by 7 to 10 days.

Front 63

List 4 complications associated with the flu.

Back 63

1. Sinusitis

2. Otitis media (ear inflammation)

3. Bronchitis

4. Bacterial pneumonia

Front 64

Describe viral infection complicated bacterial infection? What are the sx?

Back 64

Associated with sinusitis, otitis media, bronchitis, and pneumonia.

Sx: Same as uncomplicated plus chest pain, purulent sputum, hypoxemia (low O2 in blood), dyspnea

Front 65

What are the complications associated with viral infection complicated by bacterial infection?

Back 65

Confusion and death

Front 66

Describe viral pneumonia?

Back 66

Small droplets bypass upper lung causing rapid infection in lower lung.

Immune system slow to mobilize.

Sx: fever, malaise, hypoxemia, resp. failure, death.

Front 67

How is the flu diagnosed?

Back 67

Sx and Ag detection test.

Front 68

How is the flu prevented?

Back 68

Vaccines (for people most at risk...colds, immunosuppressed)

Front 69

How is the flu treated?

Back 69

1. Limit infection to upper resp. tract (best scenario, best outcome)

2. Supportive: fluids, nutrition, rest, keep warm

3. Antiviral agents

4. Tx bacterial infection, if necessary (so if complicated)

Front 70

What is pneumonia?

Back 70

inflammation of the lung parenchyma. (alveoli and bronchioles)

Front 71

What is the etiology for pneumonias?

Back 71

Infectious and Non-infectious agents.

(bacteria, viruses, fungi)
(fumes, aspiration)

Front 72

Describe the pathogenesis of pneumonia?

Back 72

Organism enters lower airways, evades host defenses, causes infection.
(virulent organism, large inoculum, impaired defenses, combo of these factors)

Front 73

What are the routes of entry for pneumonia?

Back 73

1. Inhalation from ambien air

2. Aspiration from upper airway

3. Direct spread from contigous sites

4. Spread from blood

Front 74

What are the normal host defenses against pneumonias?

Back 74

1. Nasopharyngeal

2. Glottic and cough reflexes

3. Mucociliary blanket

4. Pulmonary macrophages

(so bacteria has to get around these)

Front 75

What is 'typical' pneumonia?

Back 75

Bacterial pneumonia.

Front 76

Describe bacterial (typical) pneumonia?

Back 76

Multiply extracellularly in alveoli.

Cause inflammation and accumulation of fluid/debris in alveoli.

Sx= chills, fever, malaise, purulent sputum, elevated WBCs

Front 77

What is 'atypical' pneumonia?

Back 77

Viral or mycoplasmal pneumonia.

Front 78

Describe viral or mycoplasmal (atypical) pneumonia?

Back 78

Patchy inflammatory changes confined to alveolar septum and interstitium of lung

Less striking sx than typical

Front 79

Pneumococci is common for causing what?

Back 79

Bacterial pneumonia

Front 80

In what two ways can pneumonia be acquired?

Back 80

1. Community-acquired

2. Hospital-acquired (nosocomial)

Front 81

Describe community acquired pneumonia?

Back 81

Infections from organisms found in community.

Begins outside hospital or w/in 48 hours after admission.

Front 82

Describe hospital acquired (nosocomial) pneumonia?

Back 82

Infections from organisms found in hospital or nursing home.

Infection was not present or incubating on admission.

Front 83

How is community-aqd pneumonia diagnosed?

Back 83

Chest X-rays, WBC elevation, sputum culture (to figure out what is causing infection)

Front 84

Hospital aqd pneumonia infections occur when?

Back 84

Occurs > 48 hours post-admission.