Respiratory Infections

Common Cold

Description of Medical Condition Inflammation of the nasal passages due to any number of respiratory viruses. Usually not serious; vast majority are self-treated. System(s) affected: Pulmonary Genetics: American Indians and Eskimos at higher risk than other ethnic groups and have more frequent complications such as otitis media; individuals with certain alpha-1-antitrypsin genotypes may be unusually susceptible to the common cold. Incidence/Prevalence in USA: Preschool children 6-10 colds/yr; kindergarten 12/yr; schoolchildren 7/yr; adolescents/adults 2-4/yr. National Ambulatory Survey: 31 episodes/100 persons/year (counting only colds that lead to medical attention or at least one day of restricted activity). Predominant age: Children > adults Predominant sex: Male = Female Medical Symptoms and Signs of Disease …

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Chronic Obstructive Pulmonary Disease & Emphysema

Description of Medical Condition Chronic obstructive pulmonary disease (COPD) encompasses several diffuse pulmonary diseases including chronic bronchitis, asthma, cystic fibrosis, bronchiectasis, and emphysema. The term usually refers to a mixture of chronic bronchitis and emphysema. COPD is characterized by airflow limitation that is not fully reversible. • Chronic bronchitis is defined clinically by increased mucus production and recurrent cough present on most days for at least three months during at least two consecutive years. • Emphysema is the destruction of interalveolar septa. The disease occurs in the distal or terminal airways and involves both airways and lung parenchyma. System(s) affected: Pulmonary Genetics: • Chronic bronchitis is not a genetic disorder although …

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Chronic Cough

Description of Medical Condition Chronic cough is defined as cough of >3 weeks duration. Patients present for fear of underlying pathology (eg, cancer), annoyance, self-consciousness, hoarseness. Patients with stress urinary incontinence may find cough particularly troubling. COPD and smoking-related cough are most common etiologies at the primary care level. System(s) affected: Pulmonary, Gastrointestinal Genetics: N/A Incidence/Prevalence in USA: Prevalence of 14-23% in nonsmokers Predominant age: All age groups Predominant sex: Male = Female Medical Symptoms and Signs of Disease • Variable and related to the underlying cause • Usually nonproductive cough with no other signs or symptoms. May persist up to 6 weeks after resolution of viral illness. • Possible signs …

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Bronchiectasis

Description of Medical Condition Chronic irreversible, abnormal dilatation of the bronchi, usually accompanied by infection and productive cough System(s) affected: Pulmonary Genetics: Associated with many conditions including some that are congenital or hereditary Incidence/Prevalence in USA: • No reliable figures available • Less common than it once was, probably due to more effective treatment of childhood respiratory infections Predominant age: Begins most often in early childhood, but symptoms may not appear until later in life Predominant sex: Male = Female Medical Symptoms and Signs of Disease • Cough • Sputum — copious and purulent • Hemoptysis • Wheezing • Coarse or moist crackles • Cyanosis • Digital clubbing • Dyspnea • …

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Atelectasis

Description of Medical Condition Atelectasis (lung collapse) is a portion of lung which is non-aerated, but otherwise normal. May be an asymptomatic finding on CXR or associated with symptoms. Pulmonary blood flow to area of atelectasis is usually reduced, thereby limiting shunting and hypoxia. Diagnosis and therapy are directed at basic cause. System(s) affected: Pulmonary, Cardiovascular Genetics: Depends on basic condition e.g., cystic fibrosis, COPD, asthma, congenital heart disease, congestive heart failure, etc. Incidence/Prevalence in USA: Common in general anesthesia and in intensive care with high inspired oxygen concentrations Predominant age: All ages Predominant sex: Male = Female Medical Symptoms and Signs of Disease • Small atelectasis – Commonly asymptomatic – …

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Assessment of a Patient With Cough

Relevant Evaluation Criteria Scenario/Model Outcome Information Gathering 1. Gather essential information about the patient’s symptoms, including: a. description of symptom(s) (i.e., nature, onset, duration, severity, associated symptoms) Patient has had a cold for several days. The rhinorrhea is resolving, but the cough persists, waking the patient, her siblings, and parents at night. The cough is dry and hacking. The patient had a fever the first couple days of the cold but has not had a fever since then. b. description of any factors that seem to precipitate, exacerbate, and/or relieve the patient’s symptom(s) The cough is worse when she is put down for naps and at bedtime. She does not cough …

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Review of Colds

Relevant Evaluation Criteria Scenario/Model Outcome Information Gathering 1. Gather essential information about the patient’s symptoms, including: a. description of symptom(s) (i.e., nature, onset, duration, severity, associated symptoms) Patient’s mother says that patient has been complaining of a runny nose, mild congestion, headache, and itchy eyes for 1 week. b. description of any factors that seem to precipitate, exacerbate, and/or relieve the patient’s symptom(s) Symptoms appeared about the same time the family moved into a new home. c. description of the patient’s efforts to relieve the symptoms Patient’s parents have not tried anything. 2. Gather essential patient history information: a. patient’s identity Christy Bates b. patient’s age, sex, height, and weight 4-year-old …

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Review of Cold

Relevant Evaluation Criteria Scenario/Model Outcome Information Gathering 1. Gather essential information about the patient’s symptoms, including: a. description of symptom(s) (i.e., nature, onset, duration, severity, associated symptoms) Patient’s mother says that patient has been complaining of a runny nose, mild congestion, headache, and itchy eyes for 1 week. b. description of any factors that seem to precipitate, exacerbate, and/or relieve the patient’s symptom(s) Symptoms appeared about the same time the family moved into a new home. c. description of the patient’s efforts to relieve the symptoms Patient’s parents have not tried anything. 2. Gather essential patient history information: a. patient’s identity Christy Bates b. patient’s age, sex, height, and weight 4-year-old …

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Assessment of Colds

Relevant Evaluation Criteria Scenario/Model Outcome Information Gathering 1. Gather essential information about the patient’s symptoms, including: a. description of symptom(s) (i.e., nature, onset, duration, severity, associated symptoms) Patient complains of severe congestion and rhinorrhea for 3 days. He also has a headache and is tired. b. description of any factors that seem to precipitate, exacerbate, and/or relieve the patient’s symptom(s) Symptoms appeared 3 days ago after a trip to Chicago. Congestion and headache are worse in the morning. No symptom relief has been noted. c. description of the patient’s efforts to relieve the symptoms Patient has tried hot showers, warm compresses, and acetaminophen 500 mg this morning for the headache. 2. …

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Pulmonary Infections

Acute Pneumonias Potential Severity Acute pneumonia is a potentially life-threatening illness requiring rapid diagnosis and treatment. A delay in antibiotic treatment increases the risk of a fatal outcome. General Considerations In Acute Pneumonia Prevalence Annually, 2 to 3 million cases of pneumonia are reported in the United States. Estimates suggest that pneumonia is responsible for more than 10 million physician visits, 500,000 hospitalizations, and 45,000 deaths annually. Overall, 258 people per 100,000 population require hospitalization for pneumonia, and that number rises to 962 per 100,000 among those over the of age 65 years. It is estimated that, annually, 1 in 50 people over 65 years of age and 1 in 20 …

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