Diseases Of The Respiratory System Long Essays
Question 1. Describe the causes of bronchitis and chronic bronchitis and their clinical features, complications, and management.
Answer:
Bronchitis:
- It is an inflammation of the bronchi leading to increased bronchial secretions and airway obstruction
Bronchitis Causes:
- Smoke, atmospheric, and industrial pollutants
- These are atmospheric pollutants
- They damage the protective mucosal barrier of the nose
- Results in hypertrophy of mucus-secreting glands
- Infection
- It acts as a precipitating factor
- Physical factors
- Sudden change in temperature and exposure to fog leads to acute attacks of bronchitis
- Genetic and familial
- Alpha 1 antitrypsin deficiency leads to bronchitis
Bronchitis Management:
- Removal of etiological factors
- Avoid smoking
- Avoid exposure to pollutants
- Treatment of infection
- Antibiotics used are:
- Oxytetracycline or ampicillin 250-500 mg after every 6 hours for 5-7 days
- Cotrimoxazole- 960 mg tablets for 5-7 days
- Bronchodilators
- Oral theophylline- 150 mg BID is used
- Inhaled beta-2 adrenoreceptor stimulants- salbutamol 200 mg every 6 hours is used
- In severe cases, ipratropium bromide- 40-80 meg every 6 hours is used
- Mucolytic agents
- These include bromhexine and carbocystein
- Corticosteroids
- Prednisolone 30 mg/day for 2 weeks is used
- Oxygen therapy
Chronic Bronchitis:
- It is defined as a cough with expectoration on most days at least three consecutive months in a year for more than two consecutive years
Bronchitis Clinical Features:
- Productive cough
- Dyspnoea
- Wheezing
- Occasionally chest pain, fever, and fatigue
- Hemoptysis- the presence of blood streaks in sputum
- Complications:
- Type 1 and 2 respiratory failure
- Pulmonary arterial hypertension and corpulmonale
- Secondary infections
- Secondary polycythemia
Question 2. Describe clinical features and management of bronchial asthma.
(or)
Discuss the etiology, clinical features, investigations, and management of bronchial asthma.
Answer:
Bronchial Asthma:
- It is a disease of the airway in which there is chronic inflammation and increased responsiveness to a variety of stimuli leading to reversible airway obstruction.
Etiology:
- It is caused by various allergens, which are
- Most common
- Pollens, house dust, feathers, animal dander, insect web, fungal spores, etc.
- Less common
- Ingestion in predisposed individuals like fish, meat, milk, yeast, and wheat
Bronchial Asthma Clinical Features:
- Symptoms may be episodic or persistent
- Episodic asthma
- Sudden in onset
- Triggered by allergens, exercise
- Attacks may be spontaneous
- Duration varies from a few hours to days and even two weeks
- Characterized by wheezing, cough, and dyspnoea
- Between attacks, the patients are usually asymptomatic
- Acute severe asthma
- It is a severe life-threatening attack of asthma
- The patient may have tachycardia, cyanosis, and active accessory respiratory muscles
- Chronic asthma
- Triad of symptoms- chest tightness, wheeze or cough, and exertional dyspnoea occurs
- Cough is productive
- A prominent wheeze is audible
- Breath sound is harsh vesicular with prolonged expiration
Read And Learn More: General Medicine Question and Answers
Bronchial Asthma Investigations:
Bronchial Asthma Management:
- Management of acute asthma
- Avoidance of allergens
- Avoid allergens that may aggravate asthmatic attack
- Hyposensitisation
- Prevention of mediators of bronchoconstriction
- Sodium cromoglycate is administered by inhalation
- Useful in some cases of non-atopic asthma
- Drug treatment
- Use of salbutamol or terbutaline 100-200 meg is used
- Use of beclomethasoneupto 800 meg twice a day is used along with it
- A high dose of corticosteroids is used along with bronchodilators.
Question 3. Describe the etiology, clinical features, and management of ARDS.
Answer:
Acute Respiratory Distress Syndrome- ARDS:
- It describes the acute, diffuse pulmonary inflammatory response to either direct or indirect blood-borne insults.
Etiology:
- Direct-Inhalation
- Aspiration of gastric contents
- Toxic gases/ bum injury
- Pneumonia
- Blunt chest trauma
- Indirect-Blood Borne
- Necrotic tissue
- Multiple trauma
- Pancreatitis
- Severe bums
- Drugs
- Major blood transfusion reacion
- Anaphylaxis
- Fat embolism
Acute Respiratory Distress Syndrome Clinical Features:
- Neutrophil sequestration in pulmonary capillaries
- Increased capillary permeability
- Protein-rich pulmonary edema
- Alveolar collapse
- Progressive pulmonary fibrosis
- Multiple organ failure
Acute Respiratory Distress Syndrome Management:
- General
- Mechanical ventilation through
- Oro-tracheal intubation
- Tracheostomy
- Antibiotic therapy to treat infection
- Mechanical ventilation
- For it, three parameters are used
- Positive end-expiratory pressure- to maintain maximal recruitment of alveolar units
- Mean airway pressure- to promote recruitment and predictor of hemodynamic effects
- Plateau pressure- predictor of alveolar overdistention
- Fluid management
- By diuresis or fluid restriction
- Corticosteroids
- Methylprednisolone 2 mg/kg daily is used for 3-5 days
- The dose is then tapered to 0.5-1 mg daily
Question 4. What is pneumothorax? What are the causes of pneumothorax? How do you manage tension pneumothorax?
Answer:
Pneumothorax:
- The presence of air in the pleural cavity is known as pneumothorax
Pneumothorax Causes:
- Rupture of subpleural blebs at the lung apices
- Rupture of emphysematous bullae
- Rupture of a subpleural tuberculous focus
- Rupture of lung abscess
- Pulmonary infarction
- Bronchial asthma
- Acute respiratory distress syndrome
- Sarcoidosis
Pneumothorax Management:
- Introduction of a wide-bore plastic cannula, one end is attached to a long rubber tubing, and the other is placed underwater in a bottle
- Another method is the introduction of an intercostal catheter connected to a water seal drainage system
Question 5. Describe pneumonia, Bacterial Pneumonia, complications, clinical features, and treatment of community-acquired pneumococcal pneumonia.
Answer:
Pneumonia:
- It is defined as an inflammation of the parenchyma of the lung.
Pneumococcal Pneumonia
- It is characterized by the homogeneous consolidation of one or more lobes or segments
Bacterfial Pneumonia:
- Etiology:
- Streptococcal pneumonia Staphylococcal Aureus
- Mycoplasma
- Streptococcus pyrogens
Bacterial Pneumonia Complications:
- Para pneumonic pleural effusion or Empyema
- Lpbar collapse
- Pneumothorax
- Lung abscess
- Hepatitis, meningitis
- Pericarditis
- Myocarditis
- Septicaemia
Bacterial Pneumonia Clinical Features:
- It is sudden in onset
- Fever with chills and rigors occurs
- Vomiting
- Convulsions
- Loss of appetite
- Headache
- Breathlessness
- Chest pain
- Central cyanosis
- Haemoptysis
- Weakness
- Tachycardia, tachypnoea
- Productive cough
- Rust-colored sputum
- Rapid and shallow breathing
Bacterial Pneumonia Management:
- Oxygen therapy
- Delivered in high concentration through masks
- Analgesics
- Pethidine-50-100 mg or morphine 10-15 mg is given intramuscularly
- Antibiotics
- Oral amoxicillin 500 mg 8 hourly or
- Erythromycin 500 mg 6 hourly or
- Oral cephalosporin 250 mg 8 hourly
- Cotrimoxazole 960 mg 2 times daily orally
- Physiotherapy
- The patient is encouraged to cough and take a deep breath
Question 6. Describe etiopathology, clinical features, complications, diagnosis, and treatment of lobar pneumonia
Answer:
Lobar Pneumonia:
- Lobar pneumonia is a radiological and pathological condition referring to the homogenous consolidation of one or more lung lobes associated with pleural inflammation
Etiopathology:
- It is caused by viruses, bacteria, fungi and parasites
Lobar Pneumonia Clinical Features:
- Sudden or insidious onset
- Fever with chills and rigors
- Headache
- Productive cough
- Breathlessness
- Chest pain
- Nausea, vomiting, diarrhea
- Myalgia, arthralgia
Lobar Pneumonia Complications:
- Para pneumonic pleural effusion
- Emphysema
- Lung abscess
- Acute Respiratory
- Distress Syndrome
- Pneumothorax
- Hepatitis
- Multiorgan failure
- Formation of ectopic abscess
Lobar Pneumonia Diagnosis:
Lobar Pneumonia Treatment:
- Oxygen therapy
- High-concentration oxygen is delivered through masks
- Intravenous fluid administration
- Antibiotic therapy
- Duration of treatment-10-14 days
- Drugs used are:
- Ceftriaxone 1-2 g/day plus macrolide or fluoroquinolone
Question 7. Define and classify pneumonias. Describe the investigations, complications, and treatment of community-acquired pneumonia.
Answer:
Definition: It is defined as an inflammation of the parenchyma of the lung.
Community-Acquired Pneumonia Classification:
- Pneumonia is classified into four types
- Lobar pneumonia
- Generally, the entire lobe of the lung is involved
- Bronchopneumonia
- There is neutrophilic exudate in the bronchi and bronchiole with the peripheral spread of infection to alveoli
- Interstitial pneumonia
- There is predominant involvement of the in-interstitium, alveolar wall, and connective tissue around the broncho-vascular tree
- Military pneumonia
- Occurs due to the homogenous spread of pathogens to the lungs
Community-Acquired Pneumonia:
- It is acquired by inhalation of infected oropharyngeal secretions
- Caused specifically by highly virulent organisms
Community-Acquired Pneumonias Classification Investigations:
Community-Acquired Pneumonia Classification Complication:
- Persistent fever
- Emphysema
- Proximal bronchial obstruction
- Recurrent aspiration
Question 8. Describe the clinical features of pulmonary tuberculosis, and write short-term chemotherapy.
Answer:
Pulmonary Tuberculosis:
- Tuberculosis is a chronic infective disorder produced by mycobacterium tuberculosis characterised by the formation of granulomas and the development of cell-mediated hypersensitivity
- The involvement of the lungs by tuberculosis is called pulmonary tuberculosis
Pulmonary Tuberculosis Clinical Features:
- Loss of weight
- Loss of appetite
- Fever with night sweats
- Tiredness, malaise
- Amenorrhoea
- Cough with purulent sputum
- Haemoptysis
- Chest pain
- Breathlessness
- Finger clubbing
- Distended neck and chest veins
- Pleural effusion
Chemotherapy of Tuberculosis
Question 9. Describe the diagnosis, complications, and management of post-primary tuberculosis
Answer:
Post-primary tuberculosis:
Post-primary tuberculosis Complications:
- Haemoptysis
- Pneumothorax
- Secondary infection of the cavity
- Pleural effusion
- Emphysema
- Pulmonary fibrosis
- Scar carcinoma
- Respiratory failure
- Amyloidosis
- Anaemia
Post-primary Tuberculosis Investigations:
Question 10. Describe the etiology, clinical features, and treatment of bronchial obstruction.
Answer:
Bronchial Obstruction:
- It is called bronchiectasis
- It is defined as an abnormal and irreversible dilatation of bronchi
Etiology:
- Infective causes
- Bacterial- H. influenzae, staphylococcus aureus, E. coli, Tuberculosis, mycoplasma
- Viral- measles, adenovirus, influenza virus
- Fungal
- Obstructive causes
- Endobronchial benign neoplasm
- Foreign body aspiration
- Chronic bronchitis
- Enlarged lymph nodes
- Noninfective causes
Bronchial Obstruction Clinical Features:
- Chronic cough with massive expectations
- Haemoptysis
- Recurrent pulmonary infection
- Dyspnoea
- Fever, weight loss, anemia, and weakness
- Oedema
- Sepsis
Bronchial Obstruction Treatment:
- Physiotherapy
- Antibiotic therapy
- Ampicillin- 500 mg 8 hourly or
- Amoxycillin 500 mg 8 hourly or
- Oral cefaclor 250 mg 8 hourly
- Bronchodilators and nuicolytics
- Bronchodilators used are theophylline or terbutaline
- Mucolytics used arc bromhexine, carboys- teenie
- Surgery- indications
- Those who do not respond to medical therapy
- Those who have repeated massive hemoptysis
- Young patients
- Unilateral bronchiectasis
Question 11. Describe the pathogenesis, clinical features, and diagnosis of lung abscess.
(or)
Write etiopathogenesis, clinical features, and treatment of lung abscesses.
Answer:
Bronchial Obstruction Lung Abscess:
- It is a collection of purulent material ilocalizedised necrotic area of lung parenchyma
Etiopathogenesis:
- Infection without obstruction
- Aspiration of nasopharyngeal contents
- Involvement of various organisms like staphylococcus, Kleibsella, gram-negative and anaerobic organisms
- Formation of abscess
- Metastatic spread of infection
- Obstruction with or without infection
- Bronchus obstruction due to tumor, foreign body, lymph node
- Bronchial collapse
- Abscess formation
Bronchial Obstruction Clinical Features:
- High-grade fever with chills and rigors
- Pleuritic chest pain
- Dry cough
- The presence of copious purulent discharge
- Haemoptysis
- Weight loss, anorexia
- Emphysema
Bronchial Obstruction Investigations:
Bronchial Obstruction Management:
- Postural drainage and chest physiotherapy
- Antibiotic therapy
- Oral amoxicillin 50 mg 8 hourly for 5-7 days
- Cotrimoxazole 960 mg twice daily
- Oral metronidazole 400 mg 8 hourly
- Surgery
- Resection of part of the lung is done
- Indications:
- Massive hemoptysis
- Localized malignancy
- Associated symptomatic bronchiectasis
- Persistent abscess cavity
Question 12. Describe the etiology, clinical features, investigations, and management of pulmonary eosinophilia.
Answer:
Pulmonary Eosinophilia:
- It is a lesion in the lungs associated with blood eosinophilia
Etiology:
- Parasitic infections- hookworm disease, ascariasis, strongyloidiasis
- Allergic conditions- Hay fever, asthma, drugs like aspirin, aspergillosis
- Skin disorders- eczema, dermatitis herpetiform
- Tumors- lymphoma
- Collagen vascular disorders- rheumatoid arthritis, polyarteritisnodosa
- Hypereosinophilic syndromes- Loeffler’s syndrome, idiopathic
- Miscellaneous- Sarcoidosis, Addison’s disease
Pulmonary Eosinophilia Clinical Features:
- Dyspnoea or orthopnoea
- Wheezing
- Cough with mucoid expectoration
- Haemoptysis
- Types
- Cryptogenic eosinophilic pneumonia
- Idiopathic eosinophilic syndromes- includes
- Loeffler’s syndrome
- Hypereosinophilic syndrome
- Churg Strauss syndrome
- Tropical pulmonary eosinophilia
Pulmonary Eosinophilia Diagnosis:
- Blood examination- High blood eosinophils count
- Sputum shows eosinophilia
- X-ray of the chest shows diffuse miliary mottling of the lungs
Pulmonary Eosinophilia Treatment:
- Diethylcarbamazine- 2 mg/kg three times a day is used
- Allergic reactions are controlled by the use of antichrist-mimics and steroids
