Respiratory Diseases Long Essays

Diseases Of The Respiratory System Long Essays

Question 1. Describe the causes of bronchitis and chronic bronchitis and its clinical features, complications and its management.

Answer:

Bronchitis:

  • It is an inflammation of bronchi leading to increased bronchial secretions and airway obstruction

Bronchitis Causes:

  1. 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
  2. Infection
    • It acts as a precipitating factor
  3. Physical factors
    • Sudden change in temperature and exposure to fog leads to acute attacks of bronchitis
  4. Genetic and familial
    • Alpha 1 antitrypsin deficiency leads to bronchitis

Bronchitis Management:

  1. Removal of etiological factors
    • Avoid smoking
    • Avoid exposure to pollutants
  2. 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
  3. Bronchodilators
    • Oral theophylline- 150 mg BID is used
    • Inhaled beta-2 adrenoreceptor stimulants- salbutamol 200 meg every 6 hours is used
    • In severe cases, ipratropium bromide- 40-80 meg every 6 hourly is used
  4. Mucolytic agents
    • These include bromhexine and carbocystein
  5. Corticosteroids
    • Prednisolone 30 mg/day for 2 weeks is used
  6. Oxygen therapy

Chronic Bronchitis:

  • It is defined as 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- presence of blood streaks in sputum
  • Complications:
  • Type 1 and 2 respiratory failure
  • Pulmonary arterial hypertension and corpulmonale
  • Secondary infections
  • Secondary polycythaemia

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 a chronic inflammation and increased responsiveness to a variety of stimuli leading to reversible airway obstruction.

Etiology:

  • It is caused by various allergens, they are
  1. Most common
    • Pollens, house dust, feathers, animal danders, insects web, fungal spores, etc.
  2. Less common
    • Ingestion in predisposed individuals like fish, meat, milk, yeast, and wheat

Bronchial Asthma Clinical Features:

  • Symptoms may be epiodic or persistent
  1. Episodic asthma
    • Sudden in onset
    • Triggered by allergens, exercise
    • Attacks may be spontaneous
    • Duration varies from few hours, days and even two weeks
    • Characterised by wheezing, cough, and dyspnoea
    • Between attacks the patients are usually asymptomatic
  2. Acute severe asthma
    • It is a severe life-threatening attack of asthma
    • Patient may have tachycardia, cyanosis, and active accessory respiratory muscles
  3. Chronic asthma
  • Triad of symptoms- chest tightness, wheeze or cough, and exertional dyspnoea occurs
  • Cough is productive
  • Prominent wheeze is audible
  • Breath sound is harsh vesicular with prolonged expiration

Read And Learn More: General Medicine Question and Answers

Bronchial Asthma Investigations:

Diseases Of The Respiratory System Bronchial Asthma Inverstigation

Bronchial Asthma Management:

  1. Management of acute asthma
    • Avoidance of allergens
      • Avoid allergens that may aggravate asthmatic attack
  2. Hyposensitisation
  3. Prevention of mediators of bronchoconstriction
    • Sodium cromoglycate is administered by inhalation
    • Useful in some cases of non-atopic asthma
  4. 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
    • 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:

  1. Direct-Inhalation
    • Aspiration of gastric contents
    • Toxic gases/ bum injury
    • Pneumonia
    • Blunt chest trauma
  2. 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:

  1. General
    • Mechanical ventilation through
      • Oro-tracheal intubation
      • Tracheostomy
        • Antibiotic therapy to treat infection
  2. 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
  3. Fluid management
    • By diuresis or fluid restriction
  4. Corticosteroids
    • Methylprednisolone 2 mg/kg daily is used for 3-5 days
    • 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, its one end is attached to a long rubber tubing and the other is placed underwater in a bottle
  • Other 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 lung.

Pneumococcal Pneumonia

  • It is characterized by the homogeneous consolidation of one or more lobes or segments

Bacterfial Pneumonia:

  • Etiology:
    • Streptococcal pneumonia o Staphylococcal Aureus
    • Mycoplasma
    • Streptococcus pyrogens

Bacterfial Pneumonia Complications:

  • Para pneumonic pleural effusion or Empyema
  • Lpbar collapse
  • Pneumothorax
  • Lung abscess
  • Hepatitis, meningitis
  • Pericarditis
  • Myocarditis
  • Septicaemia

Bacterfial 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

Bacterfial Pneumonia Management:

  1. Oxygen therapy
    • Delivered in high concentration through masks
  2. Analgesics
    • Pethidine-50-100 mg or morphine 10-15 mg is given intramuscularly
  3. 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
  4. Physiotherapy
    • The patient is encouraged to cough and take deep breath

Question 6. Describe etiopathology, clinical features, complications, diagnosis, and treatment of lobar pneumonia

Answer:

Lobar Pneumonia:

  • Lobar pneumonia is radiological and pathological condition referring to 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 in onset
  • Fever with chills and rigors
  • Headache
  • Productive cough
  • Breathlessness
  • Chest pain
  • Nausea, vomiting, diarrhoea
  • 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:

Diseases Of The Respiratory System Lobar Pneumonia

Lobar Pneumonia Treatment:

  1. Oxygen therapy
    • High-concentration oxygen is delivered through masks
  2. Intravenous fluid administration
  3. 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 pneumonias.

Answer:

Definition: It is defined as an inflammation of the parenchyma of lung.

Community-Acquired Pneumonias Classification:

  • Pneumonia is classified into four types
  1. Lobar pneumonia
    • Generally the entire lobe of lung is involved
  2. Bronchopneumonia
    • There is neutrophillic exudate in bronchi and bronchiole with the peripheral spread of infection to alveoli
  3. Interstitial pneumonia
    • There is predominant involvement of the in- terstitium, alveolar wall, and connective tissue around the broncho-vascular tree
  4. Miliary 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 high virulent organisms

Community-Acquired Pneumonias Classification Investigations:

Diseases Of The Respiratory System Pneumonias Investigation

Community-Acquired Pneumonias Classification Complication:

  • Persistent fever
  • Empysema
  • Proximal bronchial obstruction
  • Recurrent aspiration

Question 8. Describe clinical features of pulmonary tuberculosis, write short-term chemotherapy.

Answer:

Pulmonary Tuberculosis:

  • Tuberculosis is a chronic infective disorder produced by mycobacterium tuberculosis characterised by the formation of granulomas and development of cell-mediated hypersensitivity
  • The involvement of 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

Diseases Of The Respiratory System 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 cavity
  • Pleural effusion
  • Empysema
  • Pulmonary fibrosis
  • Scar carcinoma
  • Respiratory failure
  • Amyloidosis
  • Anaemia

Post-primary tuberculosis Investigations:

Diseases Of The Respiratory System Post Primary Tuberculosis Inverstigation

Question 10. Describe 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:

  1. Infective causes
    • Bacterial- H. influenzae, staphylococcus aureus, E. coli, Tuberculosis, mycoplasma
    • Viral- measles, adenovirus, influenza virus
    • Fungal
  2. Obstructive causes
    • Endobronchial benign neoplasm
    • Foreign body aspiration
    • Chronic bronchitis
    • Enlarged lymph nodes
  3. Noninfective causes
    • Allergic
    • Cystic fibrosis

Bronchial Obstruction Clinical Features:

  • Chronic cough with massive expectorations
  • Haemoptysis
  • Recurrent pulmonary infection
  • Dyspnoea
  • Fever, weight loss, anaemia, and weakness
  • Oedema
  • Sepsis

Bronchial Obstruction Treatment:

  1. Physiotherapy
    • To keep bronchi dilated
  2. Antibiotic therapy
    • Ampicillin- 500 mg 8 hourly or
    • Amoxycillin 500 mg 8 hourly or
    • Oral cefaclor 250 mg 8 hourly
  3. Bronchodilators and nuicolytics
    • Bronchodilators used are theophylline or terbutaline
    • Mucolytics used arc bromhexine, carboys- teenie
  4. Surgery- indications
    • Who do not respond to medical therapy
    • 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 absces.

Answer:

Bronchial Obstruction Lung Abscess:

  • It is collection of purulent material in a localised necrotic area of lung parenchyma

Etiopathogenesis:

  1. 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
  2. Obstruction with or without infection
    • Bronchus obstruction due to tumour, foreign body, lymph nodde
    • Bronchial collapse
    • Abscess formation

Bronchial Obstruction Clinical Features:

  • High-grade fever with chills and rigors
  • Pleuritic chest pain
  • Dry cough
  • Presence of copious purulent discharge
  • Haemoptysis
  • Weight loss, anorexia
  • Empysoma

Bronchial Obstruction Investigations:

Diseases Of The Respiratory System Lung Abscess Inverstigation

Bronchial Obstruction Management:

  1. Postural drainage and chest physiotherapy
  2. Antibiotic therapy
    • Oral amoxycillin 50 mg 8 hourly for 5-7 days
    • Cotrimoxazole 960 mg twice daily
    • Oral metronidazole 400 mg 8 hourly
  3. Surgery
    • Resection of part of lung is done
    • Indications:
      • Massive haemoptysis
      • Localized malignancy
      • Associated symptomatic bronchiectasis
      • Persistent abscccess cavity

Question 12. Describe the etiology, clinical features, investigations and management of pulmonary eosinophilia.

Answer:

Pulmonary Eosinophilia:

  • It is lesion in the lungs produced associated with blood eosinophilia

Etiology:

  • Parasitic infections- hookworm disease, ascariais, strongyloidiasis
  • Allergic conditions- Hay fever, asthma, drugs like aspirin, aspergillosis
  • Skin disorders- eczema, dermatitis herpertiformis
  • Tumours- 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 chest shows diffuse miliary mottling of lungs

Pulmonary Eosinophilia Treatment:

  • Diethylcarbamazine- 2 mg/kg three times a day is used
  • Allergic reactions is controlled by use of antihista- minics and steroids

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