Respiratory System Quiz

Respiratory Disorders

• Respiratory disorders are a significant health concern in the UAE, often the second most common non-life-threatening condition.
• In 2010, respiratory infections accounted for nearly 15% of all healthcare encounters.
• The high risk for respiratory issues in the UAE is due to increased urbanization, reliance on motorized transport, traffic congestion, dust storms and rapid expansion of construction.
• Some common respiratory disorders are presented in the following subsections.

Common Respiratory Infections

• Common Cold: Viral infection of the nasopharynx.
• Pharyngitis: Caused by viruses or Streptococcus (strep throat).
• Otitis Media: Viral upper respiratory infections (URIs) spreading to the middle ear, causing edema and Eustachian tube obstruction resulting in fluid accumulation. Can become superinfected with bacteria.

Lower Respiratory Infections

• Pneumonia: Acute infection of the lungs by bacteria (like Streptococcus, Haemophilus influenzae, and Staphylococcus), or less commonly viruses, fungi, protozoa or parasites.
• Bronchitis: Inflammation of the tracheobronchial tree. Acute bronchitis is typically viral; bacterial infection may also occur.
• Tuberculosis: Acute or chronic bacterial infection caused by Mycobacterium tuberculosis, leading to granulomas, fibrosis and cavitation.

Pneumonia - Terminology

• Dyspnea: Shortness of breath.
• Tachypnea: Rapid breathing.
• Expectoration: Coughing out phlegm ("wet cough").
• Prostration: Weakness, fatigue, apathy.
• Hemoptysis: Blood in the sputum.
• Debilitated: Weak, chronically ill.
• Virulent: A strong pathogen.

Pneumonia - Pathogenesis

• Pathogens can reach the lungs via inhalation (breathing in germs).
• Aspiration (breathing in germs with fluid), including infected secretions, or infected gastric juices, foods or drinks.
• Hematogenous spread - transfer through blood.

Pneumonia - Pathology

• Exudate results from pathogenic invasion.
• Exudate accumulates in the airways and alveoli;
• Air spaces become consolidated (denser than air) which is visible on an X-ray.

Pneumonia - Signs and Symptoms

• Systemic signs of infection (e.g., high fever, chills, prostration).
• Local infection signs (e.g., secretion of mucus, cough, chest pain).
• Airways obstruction (e.g., dyspnea, tachypnea).
• Tissue inflammation and destruction (e.g., exudate causing tissue destruction and bleeding, purulent mucus, rusty sputum, hemoptysis).

Diagnostic Tests (Pneumonia)

• Chest X-ray: Identify high exudate levels.
• Sputum gram stain & culture: Identifies bacteria or virus.
• Blood tests: High white blood cell count (WBC) in bacterial pneumonia.

Pneumonia - Complications

• Pleuritis: Inflammation of the pleural surfaces with pus buildup.
• Abscess: Destruction and dilation of bronchial walls due to pus.
• Chronic Lung Disease: Lung tissue destruction causing fibrosis (honeycomb lungs).

Pneumonia - Treatment

• The primary goal is antibiotic treatment to destroy the bacterial cause along with supportive care for lung function.
• Antibiotics: Targeted for specific bacteria
• Respiratory Support: Humidified oxygen, Mechanical ventilation (for severe cases), High calorie diet for recovery, High fluid intake
• Rest: Bed rest
• Environment: Quiet, calm environment. Promoting deep breathing and coughing with the use of analgesics for pain relief.

Pulmonary Tuberculosis (TB)

• A chronic infectious disease caused by Mycobacterium tuberculosis
• Types of TB -Pulmonary TB – Tuberculous pneumonia -Extrapulmonary TB
• Different methods of spread include lymphatic, blood, and airways; swallowed into the GI tract.

Pulmonary Tuberculosis (TB) - Signs & Symptoms

• Low-grade fever.
• Dry cough (initially).
• Anorexia (loss of appetite).
• Night sweats.
• Weight loss.
• Dyspnea & hemoptysis (later stages)

Pulmonary Tuberculosis (TB) - Tests and Investigations

• CXR: Chest X-ray
• Chest CT Scan: Detailed imaging.
• Sputum Exam: Test for Mycobacterium tuberculosis.
• Tuberculin Test (skin test): Not fully conclusive.
• Immunization – BCG vaccine: Prevention method.

Pulmonary Tuberculosis (TB) - Treatment

• Multiple drugs including Isoniazid (INH), Rifampin, Ethambutol and Pyrazinamide
• Long-term treatment (typically 6 months to 2 years).
• Resistant TB forms are challenging to treat.

Chronic Obstructive Lung Disease (COPD)

• Largely a consequence of smoking , with exacerbations and remissions.
• Includes: -Chronic Bronchitis: Productive cough for 3 months of the year for 2 or more consecutive years
  • Emphysema: Abnormal permanent enlargement of alveoli and destruction of alveolar walls; without obvious fibrosis.

Chronic Bronchitis - Signs and Symptoms

• Productive cough for at least 3 months of the year for 2 or more consecutive years
• Hyperactivity of mucus glands that causes inflammation and narrowing of airways
• Factors such as smoking, air pollution, cold climates are possible causes
• May develop into pneumonia

Chronic Bronchitis - Treatment

• Diagnostic Tests: Physical exam, X-ray (CXR), and sputum culture
• Treatment: Antibiotics (if bacterial infections are involved) and physiotherapy for better expectoration.

Emphysema - Signs and Symptoms

• Chronic cough
• Dyspnea
• Orthopnea
• Tachypnea
• COPD exacerbations (acute) may lead to a quickening of symptoms and include respiratory distress, sputum production and worsening cough

Emphysema - Pathophysiology

• Bronchoconstriction: Airways obstruction; sputum production; cough
• Destruction of alveoli: Impaired gas exchange; difficult exhalation.
• Hyperinflation of lungs

Emphysema - Treatment

• Diagnostic tests: CXR to show hyperinflation, Pulmonary function tests
• Management: Treat symptoms. Stop smoking (symptoms are likely to continue.)

Asthma

• Airways obstruction (bronchoconstriction) in response to allergens or stimuli (e.g. plant pollens, chemicals, exercise, psychological stress, bronchial infection, aspirin sensitivity).

Asthma - Signs & Symptoms

• Symptoms often begin before age 10.
• Wheezing (due to bronchospasm), dyspnea, cough

Asthma - Management

• Treat symptoms with bronchodilators (inhaler).
• Status Asthmaticus is serious; repeated severe bronchospasm needing urgent medical intervention.

Lung Cancer

• Malignant tumor growth in bronchial tissue or lung.
• Common cause is cigarette smoking.
• Lung cancer is rare before age 40.
• Some lung cancers produce hormones (paraneoplastic syndromes), which can have varied clinical effects.

Lung Cancer - Signs & Symptoms

• Cough
• Wheezing
• Shortness of breath
• Hemoptysis
• Chest pain
• Hoarseness
• Weight loss
• Dysphagia (difficulty swallowing, due to tumor compressing the esophagus).

Lung Cancer - Diagnosis

• Diagnostic tests: Chest X-ray (CXR), CT scan, MRI, Tumor biopsy (possibly including bronchoscopy)
• Classification by microscopic appearance: Adenocarcinoma, Squamous cell carcinoma, Large-cell carcinoma, Small-cell carcinoma, and carcinoids.

Lung Cancer - Management

• Lung cancer management is often challenging, with limited effective treatment options in many cases.
• Treatment methods : Surgery, Radiation, Chemotherapy.
• Metastasis (spread to other sites) is a major complication.

COVID-19

• Coronavirus disease.
• Primarily spread by airborne particles from an infected person, such as when they cough, sneeze, speak, or breathe.
• Impacts vary significantly, with some individuals experiencing mild symptoms (frequently managing at home) and others needing hospitalization.
• Treatment and prevention strategies include vaccination, social distancing, mask wearing, and managing mild cases at home; for serious symptoms, seeking prompt medical support.